an important fact ...

If you have any slight desire to have your baby without drugs, you should know something very important:  the pain of contractions peaks at around 7-8 centimeters.
Of course this may vary slightly from labor to labor, but for most women, the pain will not intensify after you have reached that point.  In transition (the name given to the last couple centimeters of dilation), the contractions will most likely become closer together, but their strength will not increase.

Make sure your husband, doula, or birth partner knows this and can remind you of it when things get intense in labor.  Use that fact to help you determine if you truly can't take it any more and need a break, or if you have come far enough that you feel you can muster the courage to finish.

pros and cons of epidurals

Epidurals have some major pros, which most of us all know well.  The first is obviously pain relief.  That alone is why most women get them.  They also can give you a break and let you rest if you labor is extremely long and strenuous, or are not physically or emotionally prepared to handle the labor.  They are especially handy if you need an emergency C-section; if you are already numb they can get your baby out much quicker.

I don't think the risks are as well known, and as there are risks taken in everything we do, sometimes we brush them off, anticipating a relaxed, pain-free labor -- which many women do have.  But many do not.  "Birthing From Within" has a very comprehensive list that I will copy down and shrink a bit for you:

"Epidural anesthesia does not guarantee complete pain relief.  Most women experience decreased pain with an epidural, but not complete relief.  In fact, one study reported that 15% of the women receiving an epidural got no pain relief.  According to another study (Wuitchik, Bakal, and Lipshitz,) the average reduction in pain relief following an epidural went from the maximum score of a 10 to a 5 ....

Epidurals hinder rotation of a posterior (face-up) fetus to the more favorable anterior (face-down) position. Thorp et al.'s randomized controlled study (1989) found that 19 percent of women with epidurals had a posterior baby persisiting into second stage compared with four percent of the non-epidural group.  Failure to rotate into the more advantageous "facing down" position is responsible for increases in Cesarean births and forceps/vacuum extraction deliveries.  This is true even when pitocin is given to strengthen contractions.

Epidurals increase the use of other medical interventions and their related risks for mothers and babies. 

1. Because of the potential for epidural-induced fetal heart rate decelerations, it is necessary to use conitnuous electronic fetal monitoring.  Studies have shown that using continuous electronic fetal monitoring increases the Cesarean rate by 2-3 times (without improving the baby's outcome). ...
2. When epidural anesthesia is introduced, the mother's blood pressure often drops, causing serious fetal distress from decreased oxygen circulation.  Intravenous fluids must be administered rapidly to counteract this side effect of epidurals in the mother.  While this relieves one problem, it creates others, including excessive swelling in the mother's feet, legs, and breasts.  When the breasts are engorged, the nipple is flattened.  This makes it difficult, and sometimes impossible, for the newborn to latch on.
3. Epidural anestehsia also numbs the bladder, eliminating the sensations which signal the need to urinate.  At the same time, huge amounts of IV fluids are flowing into the mother to counteract the anticipated drop in blood pressure.  So to prevent bladder distention, a urinary catheter is needed until the epidural wears off.  Catheterization brings an added risk of bladder infection, which would then require antibiotic treatment.  Studies also show there is a 700% increase in urinary incontinence three months after an epidural.  Even a year later, incontinence remains 200% higher than in non-epidural moms.
4. As explained earlier, epidurals disturb the natural feedback system that stimulates and maintains good, strong labor.  If labor progress slows down or stops altogether, uterine contractions can be artificially stimulated with pitocin through the IV.  Pitocin, even when carefully administered trhough an electronic "pump", can cause unnaturally strong and prolonged contractions.  Such contractions decrease the oxygen supply to the baby causing fetal distress.  This risk requires continuous electronic fetal and uterine monitoring.  Unfortunately, CEFM (regardless of why it is being used) increases cesarean births.
5. One study (Murray, et al, 1981) found that the time it takes to push a baby out is longer for mothers either with an epidural (100.4 minutes) or with pitocin and an epidural (83.8 minutes) compared with unmedicated mothers (47.7 minutes).  As described elsewhere in this chapter, epidurals interfere with the urge to push, the effectiveness of pushing, the rotation of the baby's head into the most favorable position and the mother's physical capacity to choose her most effective birthing position.  That's why with an epidural there is a five-times greater likelihood that forceps or vacuum extraction will be used to pull the baby out.  Another study found forceps were used in 60 percent of mothers with epidurals, and 80 percent in mothers with pitocin and epidurals, but there were no forcep deliveries in the unmedicated group.
6. The incidence of deep vaginal tears that extend into the rectum is three times greater with an epidural (because of the related increase of episiotomy and the use of forceps).  Deep tears are painful and take longer to heal, and may later cause fecal incontinence, and chronic pain during sex.
7. Studies have shown an increase in Cesarean birth rate.  Thorp et. al. found a Cesarean rate of 17 percent in its epidural group and only 2 percent in the non-epidural group, even though the mothers in the two groups were essentially equivalent before the epidural was administered.  Thorp, et. al. (1993) reported that the earlier an epidural is begun, the greater likelihood of Cesarean:  They reported a 50% increase in Cesarean birth rate when an epidural was started at 2 cm; 33% at 3 cm; and 26% at 4 cm.  The increased Cesarean rate can be attributed to the following epidural-induced factors:
1. Fetal distress brought on by a drop in the mother's blood pressure, decreasing placental blood flow.
2. Weakening, slowing or stopping of uterine contractions.
3. Abnormal position of the baby's head, resulting from a failure to rotate and descend normally during second stage because the epidural has numbed and relaxed pelvic floor muscles (and interrupted the feedback loop).
4. Decreased pelvic diameter when the mother is forced to lie on her back.
8. Epidural fever.  The hard work of normal labor raises the mother's temperature slightly, which causes no problems.  Epidural "fever", although medically benign, must be treated more seriously.  The incidence of epidural fever is disturbing.  Among epidural-mothers, one in four will develop an epidural fever after four hours, and almost half after eight hours.  Fusi, et. al (1989) observed that, "The rise in temperature in most women with epidural did not result from an infective process, but from their inability to dissipate the heat generated in the process of labor." .... However, because infection can have serious consequences for both mother and baby, once a fever develops agreesive medical management must be undertaken.  A rise in the mother's temperature (from whatever cause) may result in a rise in the fetus' as well, causing dramatically increased heart rate and possible metabolic deterioration.  Medical management of this condition includes intravenous antibiotic therapy, and speeding up labor with pitocin, forceps, vacuum extraction or Cesarean.  Infection in a newborn is extremely serious and must be treated immediately. .... So, even before results have come back from blood work or spinal taps to show whether an infection is actually present, antibiotics and treatment must begin. At the very least this situation creates tremendous stress and worry, an emotionally painful separation from the baby, and interference with breastfeeding.  Additional medical bills immediately soar into the thousands.  All this pain, anxiety, and expense for what is usually found to be a benign epidural fever (which requires no treatment).  Yet, the workup must be done to avoid missing the timely diagnosis and treatment of an actual infection.
9. It is a popular myth that epidural medication doesn't get to the baby.  Epidural anesthetics do cross the placental barrier.  Anesthetic levels in the baby's blood have been found to be as high as one-third of maternal blood levels.  As a result, compared to the unmedicated babies, babies in the epidural or pitocin-epidural groups showed "drugged behavior" (e.g., trembling, irritability, and immature motor activity) on the first day, with behavioral recovery by the fifth day.  It takes 48 hours for a newborn to eliminate the epidural anesthetic from its system.  When pitocin was used with the epidural, there was an even greater depression of motor activity.  Babies were more tense, hypertonic, and displayed depressed reflexes.  Murray et. al. discovered that a month after birth, unmedicated mothers reported their babies to be more sociable, rewarding, and easy to care for than did the epidural mothers.  In addition, the unmedicated mothers were more responsive to their babies' cries than mothers who had epidural anesthesia in labor.  The early days of the mother-baby relationship may impact bonding and the future of that relationship.  The baby's behavior makes a powerful first impression.  When in the first month, babies appear "disorganized" (which means they are more irritable, withdrawn, look away and suckle less) mothers are more likely to perceive them as difficult babies.  That impression can affect the mother, unconsciously, in ways that shape her behavior toward her newborn, which over time, will shape the baby's personality and consequently the mother-baby relationship."

It's a lot of information, I know.  But it is important to weigh everything you can to make the best decision for your family.  Also, knowing these risks can help you to overcome them if you do get an epidural and can consciously decide to work a little harder to make sure they do not affect you as much.  You are in control of your own health, and for now, the health of your little one.

key questions about your care

During labor, you will more than likely come to a moment when a nurse or doctor suggests some intervention or procedure.  Sometimes people agree simply because they do not know what else to do, but it is a good idea to ask a few questions first.

But as you will likely be in the throws of labor, talk with your husband or partner beforehand and make sure he knows he will be responsible for communicating with the medical staff.  When something is suggested, probably the first question he should ask is, "Is this an emergency?"  If the answer to that is no, he should follow up with, "We'd like to talk about it first."

Penny Simkin made these handy little cards with questions to ask your care provider when a treatment or intervention is suggested:

1. "What is the problem?  Why is it a problem?  How serious is it?  How urgent is it that we begin treatment?
2. Describe the treatment:  How is it done?  How likely is it to detect or solve the problem?
3. If it does not succeed, what are the next steps?
4. Are there risks or side effects to the treatment?
5. Are there any alternatives (including waiting and doing nothing)?
6. Ask questions two, three, and four about any alternatives."

Of course, if it is an emergency, there won't be time to go through all that.  But if it is not, and your partner is able to get information, it will be a huge benefit.  You will be able to focus on the labor, and he will become a sort of labor guardian; a protector of your experience as a family.

(There were more questions regarding testing on these cards.  If you would like to order some, contact ICEA, 1500 Sunday Drive, Suit 102 Raleigh, N.C. 27607)

pain your body is prepared for

Another snippet from "Birthing From Within":

" 'Let me ask you something.  When you're at the dentist, would you havea tooth pulled or a cavity filled without being numbed first?'

'Well, no.'

'So why would you want to go through labor without drugs or an epidural?  Labor hurts a lot more, and for a lot longer, than having a little dental work!  You think about it, but there's no reason to suffer nowadays to have a baby.'

                        -Conversation between an expectant mother and her docter

Why indeed?

During dental procedures, nothing important is lost when you numb sensation, nor are there any significant risks involved.  For most people (older than 5) dental work is not a rite of passage; nor is it an important psychological or social transition in their lives.  Comparing the sudden, externally-induced pain of dental work (or other surgical procedures), with the pain of normal labor is a misleading analogy.

A better analogy might be the one our friend, Linda offered:  Women's bodies were intended to birth.  When baby teeth fall out naturally, we don't need anesthesia.  As labor pain unfolds and intensifies, your body produces endorphins to ease the pain.  When pain is abruptly caused by external actions, the body has no mechanism in place to help you cope with it."

endorphins

Another great excerpt from "Birthing From Within":

"How have women historically survived the pain of childbirth without the drugs?  They had no choice, but luckily, nature prepared women's bodies for such an event.

When the brain perceives pain (especially with the added stimulus of stress) endorphins are released.  Endorphins are chemical compounds secreted by the brain and adrenal glands, and have a pain-relieving effect ten times more potent than morphine.  They are also mood elevators (e.g. "runner's high").

As dilation progresses the sensation of pain will increase.  The more pain you have, the more endorphins are released to help you cope.  The rising level of endorphins contributes to the shift from a thinking, rational mindset to a more primitive and instinctive one.  Endorphins take you to the dream-like state of Laborland, which meshes well with the tasks of birthing."

Endorphins also make your memory a little hazy ... which is also quite convenient, as labor is quite intense and women might have historically fought men off if they could remember every detail. 

An interesting side note to all that:  drugs stop the creation of endorphins.  Your body is no longer under stress, and so it does not create your own pain killer any more.  So if you take some sort of drug to rest for a while, when you come out of it the pain will be worse.  So as you are progressing and things get rough, see where you are at.  The pain of contractions usually peak around 7 or 8 centimeters, so if you are about to that point, try to keep going.  See if you can make it over that hill.  But if it has been an incredibly long time and you are beyond the point of complete and utter exhaustion, take a break.  Maybe take something to numb you up for a while.  

a great use of drugs

"Natural birth" is a difficult word to define. Does it mean you went without drugs?  Does it mean you did it at home?  In the woods?  All these things are fine if it is what you want; again birth has as much to do with your mind as it does with your body.  But sometimes a good, healthy, "natural" birth does involve some drugs or intervention of some sort.

In "Birthing From Within", I just read about an account of a birth that I liked.  She said:

"I've always accomplished what I set out to do.  I've been successful in sports and my profession.  I trusted my body, and my ability to birth naturally.

So, when I was told I was not making progress, I just could not believe it.  I was physically and emotionally spent -- I had nothing left to draw on.  Facing the need to have an epidural was a crisis for me.

I needed the loving support and acceptance from my birth partner and friends to know I was doing the right thing, and that I was not weak or giving up easily.  They told me how strong I had been, and cried with me. 

Later, I realized that all my life I had been in control.  Whenever I set my mind to do something, I made it happen.  I thought giving birth and mothering would be the same way.  Losing control of my labor and having the epidural was a gift because it made me realize that as a mother I could not have the kind of control I was used to in other areas of my life.  I'm learning that though I might have ideas about my baby and mothering, I can't always control what happens.  And I'm still able to be a good mother."

I absolutely love this story.  Sometimes the more you read about all the benefits and risks with different kinds of births, the more set you become on one specific way of getting your child here.  This is a real challenge because the only thing you can really count on with your birth is that it will be unpredictable.  This carries on throughout the rest of your life as a mother. 

So as you are learning, understanding, and making decisions, keep an open mind.  Remember that birth is a perfect process, and that the medical world gives you many options.  Surround yourself during your labor with people who will love and support whatever works best for you.

the pain and power of birth

In "Birthing from Within", I found a great side note with a few thoughts to ponder on as your are deciding what kind of birth you want:

"It's important to realize that the pain and stress of normal labor are part of what keeps this natural process on track.  Here's why you should think twice before trying to eliminate pain:

1. The stress hormones produced in response to labor pain help protect your baby against hypoxia (insufficient oxygen) during labor, as well as preparing its lungs for breathing after it is born.
2. 'Pain guides the mother.  Commonly, the positions and activities she chooses for comfort are also those that promote good labor progress or help shift the baby into the right position for birth.  Remove the pain, and you kill that feedback mechanism.'
3. Removing pain also severs other feedback loops vital to normal labor and birth.  'Nerves in the cervix, and later the pelvic floor muscles and vagina, transmit stretching sensations as well as pain.  These stretch receptors signal the pituitary to produce more oxytocin, which increases the tempo of the labor, causing further cervical dilation .... and the urge to push .... Numb the nerves with an epidural, and you also wipe out the positive feedback mechanism.' "

external fetal monitoring

One of the biggest obstacles facing a laboring mother who is attempting to minimize interventions is the external fetal monitor.  Most hospitals require it continuously rather than checking every half hour or so.  That means that you will be strapped to the bed. 

This is truly a enormous problem.  Being strapped down seriously limits your movement, and movement passes time, keeps endorphins flowing, and helps your baby wiggle around to find the best position.  And then of course there are the psychological benefits of movement; most notably feeling like you are able to work with the contractions and not merely be subject to them.

So what do you do?  Obviously it is very important to monitor the baby's heart rate, but is it necessary to do it continuously?  In "Childbirth Instructor Magazine", Leah Albers CNM, DrPH said:

"Many parents and health professionals believe that serious labor complications cause fetal asphyxia and that fetal asphyxia can cause permanent brain damage such as cerebral palsy in the newborn.  Those who believe that by identifying perinatal asphyxia, EFM (external fetal monitoring) can prevent neurologic impairment have unrealistic expectations of this technology.  In fact, EFM has not decreased the incidence of cerebral palsy.  Over the past 40 years, the rate of cerebral palsy has not changed and remains at about 2 per 1,000 live births."

So then, should we just get rid of fetal monitoring?  Not at all.  Fetal monitoring is extremely important in helping to prevent all sorts of things.  Even midwives at home births monitor the heart rate from time to time throughout labor.  Keeping a constant eye on your baby does not seem completely necessary, however.

Regardless of what your wishes are with all that, your hospital will have specific policies about fetal monitoring.  Keeping it on continuously has great advantages for them; they will have the entire labor mapped out with a written record of every contraction and every beat of your baby's heart, which is very useful if ever the hospital is taken to court.  Continuous montoring is also less work for the nurses, so if they happen to have many laboring women at once they can keep a better eye on them.

More than likely your hospital will require you to have the monitor on.  I know I have talked it down so much that you are probably terrified ... but don't despair!  There is still much you can do with the monitor on.  Be sure that at least you switch sides you are lying on in bed, but if you are able, you can also set up a chair next to the bed and move to that, which will get gravity on your side.  You can also have your husband or birth partner stand next to the bed while you lean on him.  You can lay the bed flat and get on all fours, which will take a lot of pressure off your back.  And you can ask to be unhooked and go to the bathroom every couple of hours.  You should be doing this not only for the chance to walk; it will also keep your bladder flat so the baby can put as much pressure as possible on your cervix to open it more quickly.  And if you can stand it (it often seems to cause contractions to become more frequent), stay and labor on the toilet.  It is really helpful, because you will have more contractions while at the same time keeping your pelvic floor loose, so things should open up more quickly. 

Learn what the procedures are at your place of birth, and talk to your nurses.  They need to follow the hospital guidelines, but they are usually more than willing to work with you and can come up with some great, unique positions to labor in.

a nod to technology

Most of my posts have been regarding natural childbirth; our own abilities and our potential to discover them.  But let me take a moment to say simply that technology truly is a blessing.

We live in a time where the physical nature of birth is fairly well understood; doctors are trained to look for warning signs and to prevent any serious threats.  Machines calculate heart rhythms, asphyxia, amniotic fluid content, and countless other things.  Labor can be sped up or stalled, the pain can be minimalized and even taken away.  Surguries are quick and many medications can help with the healing process afterwards.

Many, many lives have been saved.

As a doula I have already witnessed the benefits of having these technological safe-nets, and have seen them used exactly as they should be to improve the health and well-being of all involved.  They were not routine, they were not to save time, and they worked side by side with the laboring mother's body -- which, in my opinion, always seems to know more than of the machines.

We are blessed to have these options available to us.  I will continue to provide more information about more natural childbirth, as that is the kind of birth in which my abilities will be most utilized.  I have also chosen to provide this kind of information because in my own life, I knew quite a bit about all the technology available to aide birth, but I understood and trusted very little in the potential of my own body.  So most in most of my posts I'll be passing along the things I am learning.

But for heaven sake, if you are in labor and miserable, don't feel guilty.  Get the help you need to make your experience a positive one.  Your baby and your husband need you to be there, physically and emotionally.

Sometimes our mindsets about pain and performance get in the way of the body's natural process of birth.  Sometimes our body's natural process is to be in labor for many days.  Sometimes our own health or the health of our babies are not up to the processes. 

We are blessed to have the option of life-saving medical advancements.

it is easier to love when you are loved

In "The Doula Book" and in "Birthing Within", a study was cited that took place in Johannesburg, South Africa.  They took 189 women having their first babies, and assigned doulas to half of them.  These doulas were to "remain with the laboring women constantly and use touch and verbal communication to focus on comfort, reassurance, and praise." The purpose was to study the long-term effects a doula has on the first several weeks after the birth of a baby.  Their findings were amazing.

To quote from "The Doula Book":

"Fewer doula-supported mothers considered the labor and delivery to have been difficult, fewer thought it was much worse than they imagined, and more believed they had coped well during this experience.  When the mothers were asked about their experiences with their babies, the doula-group mothers spent less time away from their infants.  These results suggest that doula support during labor has effects similar to those of mother-infant contact directly after delivery; both appear to increase the mother's interest in her baby and her interaction with the newborn."

Here is a graph I pieced together from numbers found in "The Doula Book":

Johannesburg Study
	CONTROL GROUP	WITH DOULA SUPPORT
Feeding Behavior at Six Weeks
Breast-feeding only	29%	51%
Demand feeding	47%	81%
Feeding food other than milk	53 %	18%
Feeding problem	63%	16%
Average number of days breast-feeding only	24 days	32 days
Infant Health Problems at Six Weeks
Vomiting	28%	4%
Cold or runny nose	69%	39%
Cough	64%	39%
Poor appetite	25%	0%
Diarrhea	33%	19%
Maternal Outcome at Six Weeks
Mother brought baby to postnatal visit	47%	64%
Mother always picks up baby when crying	40%	80%
Hours away from baby/week	6.6	1.7
Emotional State of Mothers at Six Weeks
Reported anxiety	40%	28%
Reported high self-esteem	59%	74%
Reported depression	23%	10%
Satisfaction with Partner
Before pregnancy	63%	65%
During pregnancy	48%	49%
Since the baby was born	49%	85%
Reported their relationship being better right after the birth	30%	71%
Maternal Perceptions at Six Weeks
Perception of baby
Cries less than others	17%	55%
Special	71%	91%
Easy to manage	27%	65%
Clever	47%	78%
Beautiful	67%	89%
Regards baby as a separate, sociable person by 6 weeks	80%	100%
Perception of self
Feels close to baby	80%	97%
Pleased to have baby	65%	97%
Managing well	65%	91%
Communicates well	68%	91%
Becoming a mother was easy	11%	45%
Can look after the baby better than anyone else	31%	72%

The differences here really are amazing.  If you are able to find a doula that you connect with, please use their trained services. 

But most importantly, make sure you surround yourself with people at your birth who will be supportive, loving, positive, and completely on your side.  Find a doctor you agree with.  Ask if you can trade nurses if the ones assigned to you aren't fitting.  Talk with your husband about the hopes the two of you have for this experience.  And find an experienced mother or doula to help the two of you bring about those hopes. 

Our thoughts and emotions are tied to our health just as much as the food we put inside our bodies.

for your partner

Having now been on both sides of the coin during birth, I have a lot of respect and empathy for your support person.  Typically this will be your husband, mother, or close friend.  In all cases it is someone who loves you and wants the best for you, but is often unsure of how to best help. 

If your birth partner is desiring to be very involved in the birth of your child, have them read "The Birth Partner" by Penny Simkin.  I absolutely loved this book.

Here are some of my favorite parts of a guide created by Penny Simkin for training doulas.  It is also meant to be used by the birth partner. 

1.  Pre-Labor

• The cervix will ripen, efface, and move forward.  May experience non-progressing contractions
• Mother may feel tired, discouraged, anxious.  May overestimate progress or focus too much on contractions.
• You might distract her, if possible.  Alternate with restful activities.  Try some natural labor stimulating measures.  Encourage food and drink, there is a long road ahead.  Stay with her.

2.  Latent Phase

• The cervix continues ripening, effacing, begins dilating.  Progressing contractions, some bloddy show, rupture of membranes. 
• She may feel excited, confident, optimistic, or anxious and distressed.
• You might ask what she thinks about during the contractions, suggest more positive thoughts, give her feedback and not false praise.  Try a few relaxation techniques, focus your attention on her, and remind her to drink, pee, and change positions regularly.

3.  Active Phase

• The cervix dilates from 4 to 8 or 9 cm.  The head of your baby will rotate into the best birthing position.
• She may feel she has reached "the moment of truth".  She may feel trapped, or realize that labor is not within her control.  She may become quiet and go inward, resenting interruptions.
• You should speak quietly and positively, and remind her of her progress.  Follow her lead; if she is quiet, be quiet.  Help with different comfort measures and changing positions, bathroom, and fluids.  Help her to follow her original preferences regarding pain medications.

4.  Transition

• The cervix dilates the last two centimeters, and the baby begins to descend.  Contractions will be close and the intensity will be at its height.
• She may feel lost in the intensity of it.  She may tremble, need guidance and reassurance, and vocalize or find a soothing rhythmic physical movement.
• You may need to take charge if she seems to loose it; remind her how strong she is, how far she has come, and how close she is to the end.  Hold her, do not rub her, and acknowledge her pain.

5.  Possibly a Resting Phase

• The uterus may "catch up" with the baby, whose head is now out of the uterus and in the birth canal.  There may be little or no observable activity.  Care giver may relax, or worry and start calling for pushing or pitocin.
• She may feel relief at the break, confidence, and optimism.   She may feel renewed, more aware of her surroundings, and possibly a desire to get on with it.
• You should help her change positions, and remind her of the importance to release pelvic tension.

6.  The Descent

• The baby rotates and descends.  The head will rock back and forth between bearing down efforts. 
• She will push with contractions or on demand if she is on pain medication.  She may feel inadequate, need reminders of what to do, or feel alarmed at the feeling of her baby's head.
• Be positive, report on progress.  Help her achieve effective pushing.  Remind her to release tension in her perineum, and suggest changing positions to speed progress.

7.  Crowning and Birth

• Baby's head no longer rocks back and forth, it emerges.  Perineum is most vulnerable to tearing.
• She may feel a "rim of fire", a stretching or burning.  She may avoid pushing by panting.
• Don't rush her, let her do what she needs to.  If the caregiver is directing her efforts, stay close to her and support her position.

I love this list.  I have simplified it for your partner; Penny's is a bit more detailed and useful.  But this is something, and I hope it helps.  It is important for you both to feel confident and prepared as you welcome your child into the world.  Probably my favorite thing about being a doula is witnessing the process of change between a couple as they work together to bring their baby into the world.  It humbles and amazes me.  There is nothing more incredible than witnessing the birth of a family.

everything you need to know

Happy New Year!  I hope it is everything you want it to be for your family.

I just read a quote from a seasoned midwife named Susan Stalls.  She was asked how to prepare her mothers for childbirth, and this is what she said:

"There are three things that are givens about labor:  It's hard work, it hurts a lot, and you can do it.  That's the bottom line.  All the rest you learn about is icing on the cake."

I will continue to provide a little icing for you here and there, but this quote absolutely sums everything up.