Before Labor Begins: 3 to 4 weeks before due date

What's going on?

• Lightening

• Increased frequency of Braxton-Hicks contractions

• Early effacement and dilation

• Increased vaginal discharge

• Leveling off or loss of weight (1-3 lbs.)

How is she feeling?

• Excited, sense of anticipation
• Depressed
• Has difficulty sleeping - very tired
• Has spurt of energy

What should she do?

• Simplify housekeeping
• Pack suitcase and Lamaze bag
• Conserve energy - take naps
• Preregister at hospital, if not done already
• Practice exercises, relaxation, and breathing techniques DAILY

How can I help her?

• Assist with housekeeping chores
• Encourage her to rest
• Provide diversion - take walks, eat out, etc.
• Practice relaxation and breathing techniques with her

Beginning of Labor

What's going on?

She may experience any or all of the following:

• contractions
• loss of mucus plug
• leaking or rupture of membranes
• bowel movements

How is she feeling?

• Excited
• Apprehensive
• Talkative

What should she do?

• Try to sleep if at night
• Continue normal daytime activities
• Take a walk
• Take a shower, wash hair, shave legs
• Eat a light meal

How can I help her?

• Time contractions
• Reassure her (of her readiness for labor)
• Call babysitter
• If at night, encourage her to sleep and sleep yourself
• Eat a good meal

Early Phase

What's going on?

• Effacement and dilation of the cervix from 0-3 centimeters
• Contractions 5-20 min. apart, lasting 30-45 sec. Becoming longer, stronger and more frequent

How is she feeling?

• Confident
• Sociable

What should she do?

• Relax with contractions
• Begin slow paced breathing if necessary
• Assume upright position as much as possible
• Alternate being up with short rest periods
• Empty bladder every hour
• Call physician or midwife
• Drink plenty of fluids
• Eat lightly as tolerated

How can I help her?

• Time and record contractions
• Remind her to relax, use touch relaxation
• Give encourage-ment, praise her
• Help her with her breathing, if necessary
• Offer fluids frequently
• Prepare for trip to hospital
• Encourage walking and position changes
• Remind her to urinate
• Use distractions - play cards, games, go to a movie

Active Phase

What's going on?

• Dilation from 4-7 centimeters with more effacement
• Contractions 2-4 minutes apart, lasting 45-60 sec. with greater intensity and longer peaks

How is she feeling?

• Anxious
• Apprehensive - doubts ability to handle labor
• Serious mood - birth oriented
• Attention turned inward
• Not talkative

What should she do?

• Continue relaxation and breathing techniques
• Use focal point
• Do effleurage as desired
• Change position frequently
• Continue to urinate hourly
• Adjust pillows for comfort
• Go to the hospital or birth center
• Drink fluids frequently(sports drinks are recommended)

How can I help her?

• If walking, support her body during contractions
• Assist with effleurage or offer lots of massage, stroking and counter pressure, especially on her back if it feels comfortable to her 
• Protect your back while massaging by positioning yourself close and lean into her body as you massage
• Provide cool wash cloth for face
• Give ice chips (if available) or wet wash cloth to suck on
• Offer fluids frequently
• Remind her to change positions and urinate
• Keep her informed of her progress
• Cue relaxation
• Rest when she rests
• Encourage relaxation and assist with breathing 
• If breathing seems ineffective, suggest changing pattern (make sure breathing is rhythmic)
• Watch for signs of transition
• Keep up your energy by snacking on food brought from home

Transition

What's going on?

• Dilation from 7-10 centimeters
• Contractions 1-1/2 to 2 min. apart, lasting 60-90 sec, extremely long and erratic, possibly with more than one peak

How is she feeling?

She may experience one or more of the following:

• Panicky, feels like giving up
• Irritable
• Desires not to be touched
• Forgetful, disoriented
• Rectal pressure, premature urge to push
• Nausea/vomiting
• Alternating hot/cold feeling
• Trembling of the legs

What should she do?

• Remember this phase is intense but SHORT
• Take one contraction at a time
• Change breathing technique as needed
• Eliminate cleansing breath if contraction peaks immediately
• Blow with premature urge to push
• Use slow-paced breathing between contractions

How can I help her?

• Do not leave her for any reason!
• Remind her it is transition; Labor is almost over; Baby is coming; She can do it
• Praise her lavishly for her efforts
• Do not be offended by remarks
• Screen out annoying disturbances
• Keep conversation to a minimum
• Communicate with medical staff, keep calm, do not argue
• Apply back pressure
• Call nurse if urge to push is felt
• Breathe with her-have her mimic you
• Help her catch contractions at start
• Help her relax between contractions
• Be Positive!

Pushing and Birth

What's going on?

• Dilation complete
• Baby moves down the birth canal
• Head crowns
• Delivery of head, shoulders, and then rest of body
• Contractions 3-5 min. apart, lasting 60-75 sec.

How is she feeling?

• Has strong urge to push
• Relieved to be able to push
• Renewed energy level
• Feels great deal of pressure
• Burning, splitting sensation
• Is sociable again between contractions

What should she do?

• Assume a comfortable pushing position
• Use most comfortable pushing technique
• Push only when feeling the urge
• Pant or blow as the head is delivered
• Relax perineum
• Keep eyes open

How can I help her?

• Help her assume a comfortable position for pushing (support neck and shoulders or legs while pushing)
• Remind her to relax her bottom, check her face for relaxation
• Coach her to pant or blow as head is delivered
• Remind her to keep her eyes open
• Be sure she can see in the mirror
• Take pictures as baby is born

Delivery of Placenta

What's going on?

• Mild uterine contractions
• Separation and expulsion of placenta

How is she feeling?

• Exhilarated
• Possibly fatigued

What should she do?

• Push with contractions as instructed
• Hold and soothe your new baby skin to skin
• Initiate breastfeeding
• Use breathing techniques if necessary

How can I help her?

• Take pictures of mother and baby
• Hold baby skin to skin

Bonding and Recovey

What's going on?

• Perineal repair if episiotomy was done or the perineum tore
  Identification procedures for baby
• Begin breastfeeding and bonding with baby
• Intermittent uterine contractions
• Checking of mother's physical status

How is she feeling?

• Exhilarated
• Possibly fatigued
• Hungry and thirsty

What should she do?

• Have skin to skin contact, examine, caress, nurse and talk to baby
• Make eye contact with baby
• Take pictures of father and baby
• Massage fundus of uterus
• Eat and drink

How can I help her?

• Share in bonding with baby
• Take more pictures
• Make telephone calls