• Attend antenatal classes, especially those with a home birth component.
• Write a birth plan and a plan for if you need to transfer.
• Begin using your positive affirmations and visualization tools.
• Begin using your breathing and relaxation techniques.
• Discuss any concerns with your midwife, your partner, and any other support people.
• Talk with your children about what to expect, include them if you want.
• Prepare your birth space.

Education
Firstly, be aware of how your body works during labour and birth and how the hormonal changes that take place aid your labour progress and release your body’s natural painkillers. Many women attend childbirth classes during their pregnancy. It is important to find one that supports your style and choices. Many women find the friends made during their class make a very helpful support group during pregnancy and after their baby is born as well. However, where attending classes is not an option there are some great online courses now. Also reading reputable books and factual articles can easily be done in your own time.

Parents who have had children before often ask if we think it is really necessary for them to attend antenatal classes. Most people need a refresher on labour, birthing, and the first few days with a new baby. Sharing tips and techniques brushes up the memory and brings previous experiences to the surface so that people can re-evaluate what they did the “last time” whether they were at home or in the hospital. In families where one partner is becoming a parent for the first time or neither parent has had a home birth yet or maybe there has been a few years since the last child was born, they may need both information and some peer support.

Home Birth Aotearoa in conjunction with Mamarise have created our education series that is easily and freely accessible.  These video presentations are designed to help educate people who are planning to birth at home or are exploring their options. Check them out here.

Your Birth Plan
A birth plan is a list of your preferences and wishes for the birth and the time immediately afterwards. As the process of labour is unpredictable it is good to keep in mind that the plan may need to change or be adapted. Most women only give birth a couple of times in their lives, so it is important that your experience of labour and birth meets your expectations as much as possible. Formulating a birth plan with your midwife and whānau is a good form of communication and will help your experience to be as close as is reasonably possible to your expectations and needs.

Making a birth plan will help you have active involvement in the way she/he is born and your Midwife and support people will be aware of all the issues that are important to you. It will also be helpful to talk through possible scenarios, from the best to the worst, with your partner, midwife, and supporters. By carefully considering all your ideas and preferences you will create a happier and more comfortable labour. Most midwives are willing to support the choices women and their partners make, however, some will not support all of your choices and will have a practice style and boundaries that she works within. Therefore it is a good idea to start having these conversations early in your pregnancy so that if your midwife does not feel able to support your choices you have the option of changing your midwife, you do not need to change your preferences.

Discuss your Concerns
The thought of giving birth can create anxiety and fear in many women. Birth fear is partly due to the way our culture portrays childbirth in movies and on T.V. Other people tend to share their negative or dramatic experiences, which we may take on and believe this will become our own experience. But one of the biggest reasons is a lack of knowledge. Birth is no longer something most of us are around or taught about growing up. It’s a survival instinct to fear the unknown.

Fear, anxiety, and other psychological issues can slow down or even stop labour. Instinctively when a threat is perceived, labour is shut down until we feel safe again. Fear, stress, and anxiety can cause the elevation of the hormones adrenaline and noradrenaline, which have the opposite effect of our labour-assisting hormones, by slowing down contractions and increasing the perception of pain. Talking through your fears of the unknown with your midwife and partner can help alleviate them and help you shrug off the heavy weight they bring you. Take time to connect with your baby, and trust your body knows how to give birth, just as it knows how to grow and nourish your baby. Avoid the dramatic birth stories and read positive ones or watch peaceful birth videos. Do not let others’ fears become yours.

Environment
Making sure you have a comfortable place to have your baby can be very helpful. Ideally somewhere private and relaxing with plenty of room to rest, bathe and move around. Also, darkness releases the useful hormone melatonin. Should you need to birth outside of the home you can often bring your own personal items from home to help create your own relaxing home like environment in your birthing room. Your support people can help protect your birthing space and choices.

Support
The presence of a nurturing support person such as a doula is also known to help you have a more positive labour experience. Ideally, this person is someone you know well and can help you with emotional support and guidance throughout both pregnancy and labour. They can also help with and act as an advocate for you in labour, helping you during times of uncertainty. Another role they may have is assisting with your physical comfort, providing acupressure, touch and massage.

A Note to Support People
EVERY WOMAN should have someone to offer support and encouragement during her pregnancy. As a birth partner, you will find helping during pregnancy, labour and birth very rewarding. During the pregnancy, you are there to listen and reassure. During labour and birth, you may have a very active role. Judge the situation, she may want to stay quiet going through contractions alone without being touched. Or she may need much verbal or physical encouragement, or to be distracted. Make sure you are familiar with her birth plan, you need to be aware of her wishes in order to provide her with the best care and attention during labour. Never doubt her ability to cope and give birth naturally, even if she does. As a support person, you may also have fears about the health and wellbeing of your loved ones or preconceived notions about risk and safety related to home birth. Try to be reflective and let go of what you think or fear and refocus on what you can do to improve this experience for the person you are supporting. Look after yourself too. You are the best kind of support when you are well within yourself. Prepare some good energy dense snacks and rest as and when you can. You don’t have to be a super person to be good support.

In the months and weeks leading up to your birth, you should prepare your home as much as possible for the new arrival. We have compiled some suggestions for what you may like to do in the way of preparation for your birthing space. Birth happens with or without special equipment and your preparation and level of expectations will be individualized. The purpose of this information is to provide you with some inspirations and ideas you may not have thought of yourself. It’s by no means a list of essentials, nor is it a definitive, exhaustive list. Most people have everything they need in their homes and do not need to buy anything. You can use your everyday towels, even if they are white. Simply throw them into the washing machine on a cold water rinse cycle and then wash them as normal. This is a great job for your support people following the birth, while you and baby cuddle.

THINGS TO CONSIDER FOR LABOUR AND BIRTH

• Means of heating a room
• Something to protect: your mattress and/or floor (birth mat, tarp, shower curtain, rubbish bags)
• Some towels around 6 + 2 soft ones for baby
• Washcloth(s)
• Box of tissues or wet wipes
• Plastic bags or a bin to put rubbish in
• Clean bucket/ice cream container (some women do vomit during labour)
• Container suitable for placenta storage
• Large bucket or laundry basket for dirty linen
• A clamp, tie or muka for tying the umbilical cord.
• Your midwife will bring the medical equipment.
• You may want to pack a hospital bag for you and your baby, in case you need to transfer, some people don’t and leave it for a support person to pack and meet them with it later

OTHER USEFUL THINGS TO CONSIDER

• Privacy – you may like to think about how to make a private space for yourself
• Birth pool
• Cushions, pillows, and a beanbag (useful for maintaining comfort in labour)
• Wheat bag or hot compress
• Spinal roll or rolling pin to iron away backache
• Talcum powder or lotion to avoid skin friction when massaged
• Ambient lighting – candles, lamps, fairy lights, etc
• Music or mediation soundtrack
• Affirmations for your birth space to focus on and keep you grounded.
• Oil burner if you plan to use aromatherapy.
• Mirror if you want to see baby crowning or for the midwife to use in a birth pool
• A distraction box for toddlers, and a movie or books for older children. Someone they know to be with them and support them is very helpful too.
• Have a tidy up – this is a personal preference, and some find it’s a good distraction in early labour.
• Food and drink, nourishing snacks (don’t forget to have something for your support people)
• Ice and straws
• Phone, camera or video camera

THINGS FOR AFTER THE BIRTH

• Sanitary pads – padsicles – dampened sanitary pads in the freezer
• Comfortable underwear and clothes for you
• Baby clothes and nappies
• Your preferred perineum healing mix/spray in the bathroom for application when you go.
• If planning a lotus birth, have everything you need ready.
• Have your bed made up with nice fresh sheets, a comfortable protective underlayer and everything you need nearby.
• A warm filling meal, you may feel quite hungry afterwards
• A message on your answering machine asking people to call back later/leave a message/send a text or email instead.
• A list of things visitors can do when they ask “What can I do to help?” Ideas include laundry, vacuuming, dishes, reading stories to children, taking the dog for a walk, taking out the compost, etc. It can be hard to ask for help, or hard to think of what needs to be done. If people can choose a task from a list, it can feel less awkward.
• A sign for the door or gate to say mum & baby are sleeping or express your wishes around visiting for friends and family calling by.

You might already be familiar with hormonal changes in your body, observing the monthly changes in our feelings mentally and physically as we experience ebbs and flows in our cycle. Also when you are pregnant, then the likelihood is that you may also experience the rollercoaster of emotions that your hormones may cause. Then we have birth hormones that work in synchrony to complement each other and guide the physical process of pregnancy, labour and birth and afterwards, breastfeeding. These same hormones that are so beneficial to mothers and the process of birth are beneficial for babies as well. But do you know how important they are in your labour? What do these birthing hormones do? And how do you get them to work to your advantage and to support a smooth labour and birth?

Oxytocin – The Lover
The birth hormone most talked about is oxytocin, the hormone of love, which is released in pulses from our brains during sexual activity, orgasms, the birth process and breastfeeding. The ejection reflexes, such as ejaculation and introjection that occurs with orgasm, the fetal ejection reflex during the final stages of labour, the placental ejection reflex and milk ejection are all mediated by oxytocin which reaches peak levels in these situations. Outside its role in reproduction, oxytocin is secreted in other situations of love and altruism, for example, socially bonding over a meal or playing with your dog.

During labour, the release of oxytocin causes rhythmic uterine contractions and is self-perpetuating via a positive feedback system. Oxytocin released during labour also reduces fear and is calming and provides pain relief. If left undisturbed it has a snowball effect, it gets bigger and bigger until it is unstoppable. As oxytocin pulses through the body at regular intervals, the uterus contracts and the baby places pressure on the cervix assisting it to dilate and continues until oxytocin levels peak during late labour as the stretch receptors in the lower section of the vagina are stimulated as the baby’s head passes through the birth canal, leading to fetal ejection reflex. The high levels of oxytocin continue post birth until birth is concluded with the birth of the placenta, the placental ejection reflex, and then gradually the levels subside. Good levels of oxytocin after birth also helps shrink the uterus by causing it to contract and help reduce risks of postpartum haemorrhage. During labour, the baby has also been producing oxytocin, so both mother and baby are inundated in euphoric hormones in the minutes after birth.

Oxytocin helps us in our emotional, as well as our physical, transition to motherhood. Privacy during the hour following birth is important. It allows for the opportunity for uninterrupted skin-to-skin and eye-to-eye contact between mother and baby. During this time and the baby latches onto the breast, oxytocin release is enhanced and helps set mother and baby up for a healthy bond and attachment and a desire in the mother to protect and guard the baby. Oxytocin, essentially, is love. If there is difficulty in birthing the placenta, putting the newborn baby to the breast or nipple stimulation is the easiest way to promote an increase in oxytocin levels and stimulate contractions. During breastfeeding, when the baby suckles, oxytocin is released in pulses thus facilitating the let-down reflex and sometimes very powerfully causing afterpains as the uterus contracts.

However, oxytocin is sensitive to anxiety, stress and a sense of observation. It will disappear quickly in the wrong environment which is why it is also called the ‘shy’ hormone. Disturbances to the cycle include moving from familiar surroundings to an unfamiliar setting, the presence of strangers or a change in caregivers, the suggestion of risk to the woman or the baby and monitoring techniques. The increase in catecholamines reduces contractions, and blood supply to the uterine muscles and prolongs labour.

Endorphins – The Ecstatic
Endorphins (beta-endorphins) are natural opiate like substances released during sex, pregnancy, birth, and breastfeeding and also during times of stress or pain and are a natural equivalent to painkilling drugs. During labour, endorphins help to relieve pain and if they reach high enough levels they give us an intense feeling of pleasure and euphoria like other addictive opiate substances such as pethidine, morphine and heroin

Endorphin levels are high during pregnancy and if promoted and undisturbed they increase throughout labour to offer pain relief as it is needed and to help alter our state of consciousness and encourage us to follow our instincts. Endorphins are triggered by pain but also by light touch massage, intimacy, privacy and a safe comfortable environment. Endorphins also help monitor our oxytocin levels and can slow oxytocin release and therefore contractions and pace labour according to both physiological and psychological stress so that it is more manageable. However, catecholamines and drugs such as those used for pain relief interfere with and block endorphin production.

The latest research shows that endorphins also transfer via the placenta into the baby and assist them to cope with birth by mediating pain and discomfort. They also facilitate the release of prolactin during labour, which prepares the mother’s breasts for lactation and also aids in the final stages of lung maturation for the baby. Endorphins peak in the mother after around 20 minutes of breastfeeding and pass through the breastmilk and account for the ‘milk drunk’ effect that breastfeeding can have on babies and supports the mother-baby bond when both have feelings of pleasure.

Catecholamines – The fight, flight or freeze hormones
Catecholamines (adrenaline and noradrenaline) are the stress hormones that are released when we feel anxious, hungry, cold or afraid and cause our body to go into high alert, which is not an ideal state to give birth. However, they do have a role in labour later, but if they are released during the first stages of labour then they can interfere with labour, slowing down contractions or stopping them completely, this is because catecholamines block and inhibit oxytocin release. Not only are high levels of catecholamine associated with longer labours but also adverse heart rate patterns in the baby, as they reduce blood flow to the uterus and placenta, and therefore to the baby.

However, during transition and the second stage of labour catecholamines become useful to support the very final stages where the baby is birthed. The effects of adrenaline and noradrenaline during transition, when the woman is fully dilated and not yet needing to push, can slow contractions enough to allow for some time to rest. It may also suddenly surge and leave a birthing woman feeling nauseous, dry mouthed, and shaky with dilated pupils and give the woman a burst of energy to get through the final moments of birth and activate the fetal ejection reflex. The adrenaline rush will cause several very strong contractions and if unmedicated women usually want to be upright at this time, ready to fight or flight, this rush also tends to help birth the baby quickly and easily.
After birth, catecholamines levels quickly drop and may cause the woman to feel shaky or cold. Therefore, a warm atmosphere is just as important for the woman as it is for the baby. If the mother remains feeling cold and catecholamines levels stay high this will inhibit oxytocin being released and therefore increase her risk of bleeding after birth.

Melatonin – The Dracula hormone
Melatonin is nicknamed the Dracula hormone because it is usually released at night and is suppressed by visual light exposure. Our brains produce melatonin in the late evening and through the night to induce sleep and regulate our sleep-wake cycle. It is promoted by quiet, dark private spaces and often peaks in the early hours of the morning. In term pregnancies melatonin also helps kickstart labour, and why labour or Braxton hicks are more often initiated at night. In the second half of pregnancy, melatonin levels begin to rise in the bloodstream. Then, in the last weeks before birth, the uterus begins to develop melatonin receptors, making the uterine muscle sensitive to the melatonin floating through the bloodstream. Studies on the timing of labour onset and delivery show that the initiation of labour peaks between midnight and 5 am. But melatonin on its own does not seem to directly induce labour, it works together with the primary hormonal driver of labour oxytocin and seems to act as oxytocin’s wingman. Melatonin when working together with oxytocin has the potential to increase the strength and effectiveness of contractions.

Like the other birthing hormones, the release of melatonin can be disrupted, bright lights, observation, monitoring and anxiety all inhibit the production of melatonin. You may have heard about the dangers of screen time before bed and how bright light, especially blue-green light, can suppress your brain’s production of melatonin and lead to difficulties in falling asleep. Preliminary research studied late-term pregnant women that had visual light exposure during the night and found that women who were exposed to blue/green light had lower concentrations of melatonin and fewer uterine contractions than those exposed to red light. Fortunately, during labour you can try a few strategies to help support melatonin production, labour at home for as long as you can, with the lights low, use candles, fairy lights, a lamp with a thin scarf draped over the shade to diffuse the light and keep the curtains closed, if you move to a hospital dim the overhead lights.

Relaxin – The Relaxer
Relaxin is a hormone excreted primarily by the ovaries and in pregnant women, from the placenta, as well as the uterine lining. As indicated by its name it helps to relax the body’s muscles, joints, and ligaments. Relaxin is a necessary hormone in the female reproductive cycle, which is believed to relax the uterine wall and prepare it for pregnancy. Relaxin levels are high in the early stages of pregnancy to aid in implantation and prevent premature labour. Relaxin has also been found to reduce blood pressure during pregnancy by relaxing the blood vessels.

During pregnancy, many women experience uncomfortable aches in their lower back and pelvis and discomfort from heartburn due to relaxin. The effects of relaxin are mostly concentrated around the pelvis, as softening and stretching of the joints causes them to become more mobile and decreases stability in the area. This may result in some women finding it harder to balance and their gait when they walk is out of kilter. Another side effect of relaxin is that it’s a contributing factor to reduced gut mobility and an increase in constipation. Despite these ailments caused by relaxin during pregnancy, it has an important role and peaks leading up to and during labour, to prepare the body for birthing. It softens and ripens the cervix by breaking down collagen. To assist with the birth of the baby relaxin helps to relax the pelvic ligaments to allow the pelvis to become more flexible and expand.

Prolactin – The Mother
Prolactin is called ‘the mothering hormone’ because it promotes maternal instinct, including the ‘mother bear’ response when there is a perceived threat. Prolactin helps us to put our baby’s needs first in all situations by increasing the mother’s submissiveness, anxiety and vigilance. Interestingly prolactin levels as they increase in late pregnancy, also affect people in proximity to the pregnant mother. This can mean that fathers and partners can also get a dose of ‘mothering instinct’ Anthropologists, Carsten Schradin and Gustl Anzenberger, describe prolactin as “the hormone of parenthood”. Prolactin has also been associated with the nesting instinct that kicks in close to labour and the selflessness a mother gets when her baby is born which allows her to put her baby’s needs first.

Prolactin is released during pregnancy to prepare women’s breasts for lactation and postnatally when breastfeeding, it is the major hormone of breastmilk production. Milk production is prevented during pregnancy due to the placenta producing high levels of progesterone. During labour prolactin levels drop and are lowest when the cervix is fully dilated, then rise steeply after birth. Once the placenta is birthed the progesterone levels drop and prolactin can now trigger the start of breastmilk production. Prolactin levels increase when the newborn baby suckles at the breast. Frequent suckling during those early days makes the breast more responsive to prolactin, which in turn helps to ensure a good long-term supply of milk. The intensity, duration and frequency of suckling at the breast is associated with the amount of prolactin released. When prolactin is combined with oxytocin, as it is soon after birth and during breastfeeding, it encourages a relaxed and submissive state, where the mother puts her baby’s needs first, which contributes to the baby’s physical and emotional health and a mother’s satisfaction.

Place one foot on the floor and raise the opposite leg onto stairs or a chair positioned beside you.  Point you toes outward to encourage the hips to open.  Gently lunge in and out towards your raised knees, but don’t let you knee bend past your toes. During labour you will choose your own way to move, and to be still, depending on how you feel and how your labour is progressing. You will instinctively find your own way to make your labour more comfortable, and to help your body to align with gravity during your baby’s descent through the birth.  Using different positions to stay mobile and upright during labour can help you to progress more quickly  and birth easier.

When you are in labour your body produces an ‘internal cocktail’ of birthing hormones, which regulate and stimulate the involuntary muscular responses of your uterus. They also promote attachment and love. When you have the freedom to move and can labour in a peaceful and private place where you feel safe, undisturbed and unobserved, you are able to release very high levels of Oxytocin and Endorphins. They are natural relaxants that stimulate good contractions and help you to cope during labour.

Many of the following positions allow you to rock, sway and rotate your pelvis, open your pelvis and help position baby and assist with baby descending. If your labour slows, changing position every 20 minutes or so, may help to get it going again.  Remember, what’s comfortable in one phase of labour may not be in another. Follow your instincts to find the right positions and movements for you.

UPRIGHT POSITIONS
For many women, the ability to move while standing or simply walking around the room, combined with gravity, helps labour progress. Hugging your partner around the neck and swaying is one method to give birth in this position Another good choice is to lean against a wall or support yourself against some heavy furniture. However, if you are pushing for a while or if your labour has already been a lengthy one, this position may be exhausting, so take care not to become too tired.

Pros:

• Movement helps labour to progress by shifting hips side to side
• Opens pelvis, allowing baby to drop farther and push on the cervix
• Helps baby rotate and get into a better birthing position
• Helps baby rotate or descend

Cons:

• Can be tiring, especially if you’ve been in labour for a while
• May require a partner for balance

Walking
Some women like the sense of control and the distraction they get from walking during early and active labour. If your labour is slow to start or progress, walking can help establish contractions. The rocking from side to side or rolling your hips while walking helps realign your pelvis and lengthen your body, which in turn helps your baby move into the birth canal.

Stair-climbing
Climbing and descending stairs is excellent for maintaining mobility. If you are in the early stages of labour, it also helps pass the time. If labour has been going well but then starts to slow down, you might want to think about climbing steps, as it can help the baby shift into a better position. Consequently, if your baby is posterior (their back against your back), going up and down stairs sideways may help them to rotate and descend. During contractions, you can stop to lean against the wall or on your birthing partner or hold the handrail.

Standing forward lean
While standing with your feet at a comfortable width you can lean against a wall lean, on a piece of  furniture or countertop with your upper body supported by your arms. During contractions, you can freely sway from side to side. Alternatively, with your birth partner you can wrap your arms around their neck or waist, leaning into their chest or shoulder and sway as if you’re slow dancing. This is also a great position for receiving a back rub. Swaying back and forth in rhythm with your breathing or to music can be comforting during labour and cuddles are good for getting an oxytocin boost, but keep in mind not everyone wants to be touched when in labour.

Standing lunge
Place one foot on a sturdy chair or stool and lean into that foot, stretching your muscles and ligaments on that side. Ensure your knee does not extend past your toes. Lunge between contractions, or during contractions, whichever provides you the most comfort. One side might feel comfortable, while the other side experiences discomfort. If this is the case, simply concentrate on the side that feels most at ease. If this posture hurts your hips, knees, or pelvis, avoid using it.

SITTING POSITIONS
When you sense your baby’s weight pressing into your pelvis or your legs need a break from standing, It’s okay if you just want to sit down to rest and get more comfortable. Sitting with your legs in an open position during labour can ease some of the pressure on your pelvis, helps open up your pelvis and allows gravity to encourage baby downwards. You can sit on a chair, facing either forwards or backwards, an exercise ball or even on the toilet, or you may want to try sitting with one knee bent and the other relaxed or sit cross-legged on a bed or the floor.  Whatever is available and works best for you, just don’t lean too far back. When you sit upright, your uterus drops forward, improving the blood supply to the contracting muscles and helps position baby.

Pros:

• Good for resting
• Sitting on a toilet relaxes the perineum, which can help reduce tearing
• Upright positions help to open your pelvis
• Gravity will encourage your baby to move downwards
• If baby’s head is pushing on your spine it may help him/her to move forward
• Rocking or swaying from side to side may also help baby move into a better position
• A good position for someone to apply pressure on your back

Cons:

• A hard seat can become uncomfortable, try placing a small cushion underneath for comfort.

Sitting forward lean
Leaning forward while sitting is an excellent way to make use of gravity, which aids in the descent and rotation of your baby and the opening of your cervix. You can request a back massage/mirimiri or counter pressure on your hips and sacrum from your birth partner, to help ease any back pain, while you’re in this position. Try leaning forwards onto a bed or facing your birth partner to rest your upper body. Make sure to open your legs to a comfortable and secure distance for you, especially if you experience SPD in your pelvis. If using an exercise ball you can sway or rock in this comfortable position as you go through labour. Remember to inflate the exercise ball to the point where your legs are lower than your hips and have someone or something to support you as you may become unsteady.

Sitting backwards cowboy style
Facing the back, straddle an armless chair or toilet seat with your bottom as far back as possible. Lean into the chair, resting your arms and head on the top of the seat, you can place a pillow between the back of the seat and your abdomen. This position relieves some of the strain on your back and frees it up for your partner to massage or apply counter pressure. If you have a stool or chair made of plastic or stainless steel, try sitting in the shower in this position while allowing the warm water to run down your back.

SQUATTING POSITIONS
Squatting works with gravity, enlarges the pelvic opening and can shorten the second stage of labour, as it can be especially effective when pushing. To help maintain your balance you can use the furniture in the room to support yourself, squat with a partner from behind or in front, or even suspend a rebozo from the ceiling or over a door. This position requires some strength to sustain it and can be exhausting. If you’re feeling tired during labour, take breaks and switch postures. Your thighs might start to feel like they’re going to turn into jelly or you might get the shakes. Squatting should be practiced during pregnancy to help strengthen your legs for squatting during birth.  

Pros:

• Uses gravity to assist your baby to move down
• Helps expand the pelvis by up to 30% more compared with lying on your back
• Gives baby room to maneuver as they head toward the birth canal
• Helps with dilation

Cons:

• May become tiring
• Baby’s position may not be right for squatting

Semi Squatting
Two support people should be seated on a bed or chairs with their feet firmly on the ground. You can then position yourself between them or with your back facing them. You can place an arm around each of their shoulders or they can take an arm each. During a contraction, you can drop down into a half squat, with your support people taking your weight.

Supported squat
Have your birthing partner hold you under the arms so you can rest in a squat position. Gravity and a wider opening of the pelvis can help your baby to descend. If you hold this position for a long time, the blood supply to your lower legs is likely to be affected. Mix it up with all-fours or side-lying positions when you feel the need to move. This position might not be suitable for you if you have pelvic pain.

Hanging squat
You can grab a bed rail or a window sill and hold onto it. You might also attempt hanging from your partner’s hands or an open door. Some people have anchor hooks in their ceilings or open ceiling beams that are strong enough to support their weight when they connect a rebozo or something similar. During the second stage of labour, hanging might offer you the comfort you’re looking for. For comfort, try placing a yoga mat or pillow under your knees, and slowly rock yourself throughout contractions. Your partner an sit or stand with feet wide. Position yourself between your partners legs, then hang in an upright, supported squat – letting your partner support you with their arms, hooked under your armpit area.

KNEELING POSITIONS
Kneeling is one of the most popular birthing positions because it also gives you a much-needed break. If upright positions are tiring, or the contractions are too fast or overwhelming, kneeling positions can help. baby is posterior, their back against yours, kneeling can help them turn to get into the proper position and ease back pain. Additionally, these are excellent positions for someone to apply counterpressure. massage/mirirmiri or apply warm/cold compressions to your lower back.

Pros:

• Relieves pain of contractions
• Eases back pain by taking pressure off the spine
• Keeps pelvis tipped forward allowing more room in which the baby can move
• Excellent anatomical position to birth any baby but especially breech babies

Cons:

• Your arms may get tired

Hands and knees / All fours
Similar to the position you would assume if you were washing the floor, keep your arms vertically below your shoulders, not too wide, and allow your body to rest on your arms. If your wrists get tired, you can lower your upper body and rest on your forearms. or try resting your upper body on a chair or birthing ball, with a cushion or pad beneath your knees. Swaying, rocking, or circling your hips or arching your back from time to time can help reduce back pain, as can acupressure, hip squeezes and warm/cold compressions. During the final stages of labour, you may need to widen your knees in order to open up your pelvis and made room for baby to be born.

Supported kneel
Your knees and feet might get sore so it’s best to kneel on a soft pad or mattress. Then lean forward onto a ball, a bed, a couch, or your birthing partner’s shoulders or lap. This way you can stay upright to keep your labour going while taking some pressure off your back, which is good for everyone but especially those experiencing back pain. In comparison to sitting or lying down, a supported kneel provides more space in your pelvis. This is also a good position to get into if your placenta is delayed.

Hanging Kneel
Hanging may provide the relief you’re craving during the second stage of labour. Try putting a yoga mat or pillow under your knees for comfort and rock yourself gently during contractions.You can hang onto a stair rail, a window sill or a taller piece of sturdy furniture, like a headboard. You could also try hanging from an open door or your partner’s hands. Some people have anchor hooks in their ceilings or open ceiling beams that are strong enough to support their weight when they connect a rebozo or something similar. During the second stage of labour, hanging might offer you the comfort you’re looking for. For comfort, try placing a yoga mat or pillow under your knees.

LYING POSITIONS
Semi reclining or lying on one’s side are comfortable resting positions, particularly in between contractions. They do not use gravity like the other positions, so that is something to take into account. Also, holding your leg open while pushing may require some assistance. If your labour slows down while you’re in this position try getting up and mobilising again, if you are able to.

Pros:

• Can release tension and relax the muscles
• Takes pressure off your internal organs
• Nice restful position
• Can help slow down a too-fast birth
• Can be used if you have high blood pressure
• Makes it easier to relax, even sleep between contractions

Cons:

• Can work against gravity

Semi reclining
Given that giving birth is demanding and hard work, you might want to take a much needed break and rest between contractions or conserve some energy. Many women choose reclining birthing positions as you still have some of the benefits that gravity provides more than if you were to lie flat. You can recline against a wall, a chair, a pile of pillows, or another person in addition to reclining in bed. Your lower back and tailbone may feel uncomfortable from the added pressure When it comes time to birth your baby, to open your pelvis and give your baby more space to be born, you might want to try other off-your-bottom positions.  When pushing you can grab your legs behind your knees and pull your knees up towards your armpits, like a deep squat, this will curve your back and take pressure off your bottom and help open your pelvis.  Alternatively, if you have two support people, they can place themselves on either side of you and hold your legs in a squat position while you push.

Side-Lying
This position can give an exhausted labouring woman a much-needed break, while avoiding the compression of major blood vessels that may occur when lying on the back. If you are having a lot of back pain during labour, you can also ask your birth companion to apply gentle counter-pressure to your back to relieve pressure from the baby’s head moving down. To help keep the pelvis tilted forward, lie comfortably on your left side with your upper leg raised and your lower leg bent. Use a partially deflated beach ball or a large firm pillow between your knees to support your upper leg or ask your birth partner to do so. A side-lying lunge can open up your pelvis by bringing your bent knee higher up towards your belly. Experiment to find a position that feels comfortable and allows you to relax deeply. If pushing while lying on your side: Bend your knees with the bottom leg resting on the bed and your birth companion supporting the other leg during contractions.  If they stand or kneel behind your knee area, you can place the shin/calf of your upper leg on their shoulder, if this is okay for them.

Water birth is one of the most commonly recognised methods of birthing at home. Pool hire is one of the primary functions of our regional home birth groups across Aotearoa. Waterbirths require little technical skill or practice which makes them suitable for almost any birthing woman. The temperature and sensation of the water helps reduce pressure and pain in the birthing woman and promotes good positioning to birth baby. Water is often used as a pain management tool with or without the actual birth taking place in the water. It needs to be stated that waterbirth, although a desirable choice for some women, is simply an option, not an end to be achieved in every birth. When women have a birthing pool or bathtub available, many gravitate to it without hesitation and feel safe to stay in and birth their babies.

BENEFITS OF WATER 

Pain relief
In the water, one’s perception of ‘pain’ seems to alter. It becomes easier to accept the intense contractions and resting in between contractions is likely to be even more relaxing in the pool, than on land.  In water, the nerve endings on your skin send messages of warmth and touch and create a large number of pleasurable sensations which will help reduce the amount of pain you feel. Water also helps with the release of endorphins, which help inhibit or block the transmission of painful impulses in the spinal cord and brain. Our bodies produce adrenalin when fear is present, so by keeping it low, we also decrease the sensation of pain and discomfort, and keep our body relaxed.

Relaxation
Labouring in water makes it easier to change positions and float freely and can provide a safe private birthing space, where you may become less aware of those around you and more able to move with your body’s primitive and instinctive urges. It becomes easier to rest in between contractions and cope with the intensity of contractions.  When in a relaxed state, your body will be producing more useful hormones facilitating a smoother, quicker progression of labour.  In turn, when fear is present, our bodies produce the hormone adrenalin increasing the sense of pain and discomfort, tightening everything up and potentially leaving us with a longer, more distressing labour.

Increased Sense of Privacy
Being in a pool, in your own space can give you a sense of privacy and help you feel less observed. You may become less aware of those around you and more able to move with your body’s primitive and instinctive urges. Also, the people in the room tend to speak in quieter tones and move more gently.  Creating a quieter atmosphere which also helps you to relax.

Ease the trauma of birth
Birthing in the water offers the gentlest transition from the watery womb into a world of gravity, noise, and light, for your baby.  As the baby is crowning, the warmth of the water may soften the perineal tissues. It is unusual for a bad tear to occur during a water birth. Generally, the baby emerges gently into the water without the need for any assistance.

Attachment
Being in the water with your newly born baby is an amazing way to experience that first contact with your baby, as it gives you some one on one time together. It may be just you and your baby in a private world bordered by the pool. While you are still in the warm water, you may latch and allow the baby to suckle at the breast, helping with the bonding and helping the placenta come away easier.

The Mess
The concern about any ‘mess’ is alleviated.  If you are in the pool at the time of birthing, it all just goes into the pool and can be easily emptied into your garden or to your waste drain. With the use of a large plastic sheet or tarpaulin under the pool and beside your pool, your floor will be protected from any splashes and also for when you exit the pool.

COMMONLY ASKED QUESTIONS

Is it safe?
Provided you have an uncomplicated labour, yes.  However, there are some things to be aware of and prepared for.

• Dehydration and Over-heating – Monitor fluid intake, and ensure plenty of water is going in regularly. Especially when the temperatures are warm, water loss is great and something as simple as keeping hydrated can help your labour go smoothly.  Monitor core body temp. not necessarily by taking your temperature, but by checking how you are feeling, having someone touch you and watch you, and monitoring the room temperature.  Have some cold cloths and ice available to either suck on or place on your body, such as the forehead or back of the neck.  Ensure the water temperature is not too hot. 
• Slipping due to water spillage – Ensure any loose plastic from the pool liner is tucked under the pool out of the way or taped down to avoid it becoming a tripping hazard.  It is important to cover any exposed areas of polythene as it is deadly slippery when water is on it. Mop up any water spillage as soon as it occurs. If you are getting in and out often, it makes sense to use the same point and lay down a bath mat or large towel. Plastic floor protection can get very slippery and become a hazard for everyone present.

Why doesn’t the baby breathe underwater?
Understanding how a newborn takes its first breath helps to dispel any fears concerning the safety of waterbirth.  While in the uterus the baby does not need to breathe, as during the pregnancy the baby receives oxygenated blood from the placenta, delivered by the umbilical cord and then deoxygenated blood carrying waste returns back to the placenta to be purified and reoxygenated ready to return to the baby. It is not until after the baby is born and their skin senses the change in air pressure and temperature, that the complex physiological process resulting in the first breath begins. During those first seconds after birth when the newborn is underwater, which is a similar temperature to the mother’s body temperature, it is not stimulated to breathe and the baby continues to receive oxygen from its mother via the umbilical cord. This is part of the gentle transition that waterbirth can provide and allows a few moments for the baby to stretch before being lifted out gently.  While the umbilical cord is intact and the placenta is functioning, the baby will remain in the same steady state it was in before and during the birth.  However, it is essential for the newborn to be brought out of the water in a timely manner after birth before the process of placenta separation begins and alters its function.

If I’m in labour, when can I get into the water?
The decision of when to get in the water and when to get out should be left up to the mother if everything is proceeding normally. Some research suggests that labour time may be lengthened if the woman enters the pool before well established labour, roughly 5cm dilated.  It is thought that if the woman enters the pool early, the water can relax the woman too much, and the labour often slows down and lengthens her labour.  If this is the case, the woman can leave the water until things get going again. Staying active during labour is the most beneficial thing a woman can do to facilitate progress.  Some women alternate between walking, taking showers and various positions during labour.

What temperature should the water be?
The best gauge is the mother’s comfort, usually about 35 degrees Celsius is comfortable, however, when the baby is about to be born, the pool should be at body temp – 37 – 38 degrees Celsius, so more hot water may need to be added near the final stages of labour.

What about monitoring?
Your Midwife will check with you regularly to ensure you are not overheating.  They can listen to the baby by either asking you to raise your abdomen to the surface or using their Doppler in a plastic bag if it is not a waterproof model.  The observations the midwife makes are no different whether you labour in water or on dry land.  Sometimes being in a pool is a useful way of ascertaining the real importance and necessity of some monitoring and helping keep it to a minimum.

What about infection?
There is no increased infection between those women who birth on dry land and those who deliver in water when the pool and equipment are cleaned and used correctly. You can wipe around the pool before filling it using a mild bleach solution or use antibacterial wipes available from your supermarket. To minimise the risk of cross-infection it is recommended you use a disposable liner. It has been suggested that the use of a pool might even reduce the risk of infection as bacteria are diluted.

Do you deliver the placenta in the water?
The choice to deliver the placenta in the water is a decision to be made by the mother.  Midwives who deliver the placenta in the water report that it is safe and without side effects. In the water, the umbilical cord is usually not cut or clamped until the placenta is out of the woman’s body and is birthed without cord traction or abdominal pressure.  Some midwives state that the time allowed for the passage of the placenta increases slightly with birth in water. It is their general feeling that the water relaxes the uterus and that the contractions for birthing the placenta are less effective in the water. Often with gravity, when women stand up to get out of the tub or change position the placenta virtually falls out.

How are emergencies handled in the water?
Midwives who include waterbirth in their practices carefully monitor the progress of the birth and the baby’s status throughout labour, just as in any birth. If an emergency is encountered the situation is assessed and the proper course of action is taken. This may require the mother to get out of the birth pool or simply change positions. Each midwife uses their judgment and level of experience during labour and birth to guide them.

What about bleeding?
Your midwife will monitor the colour of the water and be able to see if you are bleeding a lot.  If you feel faint or dizzy let your midwife know immediately.  It is a good idea to have something ready to lie on outside the pool if you do have to leave the water urgently.  Also, your support people need to be aware that they may need to assist you.

Why may I need to leave the pool?

• Because you want to
• Because your contractions have slowed and you are keen to get them going again
• Because you feel too hot or too cold
• Because your LMC has a reason for you to do so, such as an obstetric emergency

Home Birth groups that offer pool hire, for more details, visit our community groups page 

• Auckland Home Birth Association
• Waikato Home Birth Association
• Coromandel/Hauraki Home Birth
• Trust Home Birth Tauranga
• Taupō Home Birth Community
• Manawatū Home Birth Association
• Wellington Home Birth Association
• Birth Wisdom Golden Bay
• Choice Baby Nelson
• Canterbury Home Birth Association
• Te Whare Tangata Home Birth Selwyn
• Positive Birth Dunedin
• Birth and Baby Support Southland

We live in a society that teaches women to fear birth which in turn causes anxiety, by portraying it as being a painful and traumatic experience. The trust in a woman and her body’s ability to instinctively give birth has been eroded. Horror birth stories depicted in novels, movies, marketing campaigns, and from other Mothers have all played their part. When we are fearful or stressed about birth a lot of the essential birth process is inhibited. The fight or flight takes over and causes physical reactions in the body, tightening of the muscles, reduced blood flow to the uterus, heart, lungs, and limbs, and the release of stress hormones and adrenaline which can slow or stall childbirth and increase the pain and discomfort. A deeply relaxed mother helps facilitates the oxytocin flow and physiological birth.

An athlete would never compete without ensuring that their body and mind was conditioned, why should birthing be any different? Conditioning needs the time and dedication of both your mind and body. By practicing these techniques during pregnancy, they become second nature and instinctive and women can call upon them to help themselves stay calm and in control when needed, to birth easier and without intervention. No matter what happens during your birth, relaxing can help make things easier, less painful, and quicker. When you’re relaxed and feeling happy or positive, you get the perfect opportunity to open the sphincters in your body that release your baby.

One technique that helps women get ready for a positive and serene birthing experience is hypnobirthing. The programme takes into account both the mother’s psychological and physical health, as well as how the release of feel-good hormones can make childbirth easier, often more swiftly, and comfortably. As women become more conscious of their bodies’ natural capacity to give birth, they gain more power. A positive and empowering birth with reduced interventions can shorten the recovery time and allows for better and earlier bonding with the baby, which has been proven to be vital to the mother-child bond. Couples learn how, when the body is relaxed during labour, the muscles of the uterus work in perfect harmony to open the cervix and move the baby down in hypnobirthing courses. In addition to this information, a variety of simple breathing and relaxation techniques are taught to aid in the birthing process rather than impede it.

Calmbirth is another childbirth education programme that is helpful for preparing women for birth. Calmbirth does not advocate for a particular method of childbirth; rather, it focuses on assisting couples in overcoming their fears of childbirth and creating a positive birth experience, regardless of how the birth occurs. Instead of resisting the labour journey, the programme teaches mothers to use their inner resources to work with birth and to help them understand the process of birth.

Breathing – Rhythmic breathing during labour helps your body maximise the oxygen to your baby, essential to her wellbeing. It also helps you to move through your surges, relieve tension and conserve energy throughout your labour. Practicing your breathing techniques several times a day in the weeks leading up to your baby’s birth is recommended. Your birth partner can help by practicing with you so that he can mirror your breathing rhythm and encourage you to stay calm, focused, and positive during labour.

• Relaxation Breathing – This breathing technique is used to create a calm and profoundly relaxed condition. This breathing is ideal in pregnancy and the very early stages of labour and in between surges, to instantly bring you to a relaxed state and conserve your energy. Breathes are a short in and long out In… 1, 2, 3, 4 Out… 1, 2, 3, 4, 5, 6, 7, 8
• Surge Breathing – When you are in an established labour during contractions, this breathing is optimal. By breathing in this unique way, it reduces any strong sensations to a more manageable level. This breathing also makes each surge more effective, so you can often reduce your birthing time. The length of the breaths are the same count in and out In… 1, 2, 3, 4, 5, 6 Out… 1, 2, 3, 4, 5, 6
• Birth Breathing – You can use this breathing technique during contractions when birthing your baby. Follow your body’s lead and work effectively with your body, allow the urge to push build, then take a power breath in and a long slow breath out, with relaxed open mouth “Ohhh’ ‘Arhhh’

Deep Relaxation – Mum becomes adept at falling into a deeply relaxed state quickly and easily, while remaining alert and present. Your cervical and vaginal sphincters will open easily when you are relaxed, at peace and even happy. When we feel watched or when we feel upset, they close. This is why it is harder to birth our baby if we are under a lot of stress and when we feel afraid. The rush of adrenaline in our bloodstream causes the sphincters to stay closed and muscles to leading to slower cervical dilation and a longer, harder labour. You can help open your cervix and vagina under the right conditions.

• Open your mouth when you are in surge, this will open your cervix.
• Open your throat when you are birthing your baby, this will open the vagina.
• Create an atmosphere of privacy.
• Relaxation is vital.
• Ensure you are confident in birthing your baby and have overcome any fears.
• Laughing your sphincters open

Affirmations – replacing any negative language or beliefs with positive and empowering statements, ‘My baby is the perfect size for my birthing body’, ‘My baby is in the optimal position for descent and birthing’.

Visualisation – Picturing and imagining the birth playing out in the best way possible from early in the pregnancy to guided imagery for Mums to use while birthing. Images may include visualising the cervix opening like a flower or picturing baby moving freely and easily down the birth path.

Releasing fears – Couples are guided through relaxation scripts specifically crafted to remove any negative or limiting associations with birth that may affect their birthing outcome. This is particularly poignant for anxious Mums-to-be and those with unresolved issues around previous births.

Reasons why you may consider Self Hypnosis, Breathing and Relaxation

Gives You Confidence
One of the key elements that will enable you to stay at home is confidence. Belief in your body and baby’s ability to do the job they were perfectly designed to do is vital. Immersing yourself in hypnosis techniques is the perfect exercise for building up your confidence muscle as you approach the labour and birth.

Familiar Surroundings Aid Birth
Being in an environment that feels familiar is a huge plus point when it comes to feeling safe. Gaining an understanding of how these feelings release the positive hormones and emotions that make it easier for you to give birth, often more comfortably, quickly, and enjoyably.

Learn How to Create a Nest
Along with the familiarity of your home, you’ll also learn how to ramp up the everyday comfort of your, living/birthing space turning it into a nest. In birth everything you do is about the promotion of endorphins and oxytocin, the body’s feel good and natural pain relieving hormones. Creating a nest is key.

Stop Engaging in Other People’s Fears
One of the things you may experience is was the raised eyebrows and the ‘you’re brave’ comments for staying at home or ‘you must be bloody crazy’. Well-meaning or not, conversations like this undermine your confidence. Most good birthing courses will help you to by-pass other people’s negativity and fears, so you can focus on creating the positive homebirth you have been dreaming of.

Get Your Partner More Involved
The whole pregnancy and birthing process can be an intimidating and/or isolating for some birth partners. Hypnobirthing type techniques helps you to create the time and space to discuss your needs as a family. Whilst providing your partner with specific tools they can use during your pregnancy and on the day the you welcome your baby into the world, so they feel confident and an integral part of the entire journey.

Stay Calm and Positive During Labour and Birth
The ability for you and your birth partner to stay calm during your labour, whether you are having a straight forward or a more challenging birth is absolutely key when creating a positive birth experience. You will learn how to do this through various breathing, relaxation and visualisation techniques.

Navigate the Natural Twists and Turns of Labour with Ease
One of the phrases you may hear is ‘understanding what you can control, letting go of what you can’t.’ Hypnobirthing provides you with a solid foundation to ensure you feel calm and confident, no matter what situations you are presented with, rather than creating ‘perfect text book births’. This is empowering for both you and your partner, particularly if you have to navigate situations that aren’t on your birth preferences.

Pain Reliever
While pain is so subjective, it is worth considering the anecdotal evidence provided by thousands of hypnobirth users who report ‘less painful’ births. When a labouring woman is relaxed and working with her body as opposed to fighting against it, the birthing process is made much easier for her and her baby.

A Calm Environment is Great for Siblings
Many mums worry about what they will do with older children when considering birthing at home. When your environment feels very calm and you and your birth partner feel in control, which is what hypnobirthing is designed to do. Having other children in the house can make the birthing experience even more magical.

There are a number of ways you can help ease your discomfort during labour and make yourself more comfortable while at home.  Many women use one or more of these techniques at different stages of their labour. Here is an overview of some of the drug-free pain relief choices, you may want to try during your labour.  Some of these are done throughout your pregnancy, such as education, choosing your safe birth place, and surrounding yourself with nurturing support people. Research shows that using one or more of these methods in your labour might help to reduce stress and increase natural hormone levels including oxytocin, prolactin and beta endorphins.    These hormones naturally peak in late labour and contribute to effective labour progress and provide natural pain relief.  Research also shows that increase levels of these hormones may also promote contractions, reduce risk of bleeding and support successful breastfeeding.

Positioning
Moving and changing positions to help control labour pain is one of the oldest known coping strategies.  As well as providing comfort, support people can help, suggesting certain positions to help with labour progress or to correct any issues with you or your baby.   Especially early in labour we know that upright and walking positions can help to make your labour faster or reduce your chance of other interventions and usually aren’t associated with any harm.  

Acupuncture and acupressure
These techniques have been shown to reduce the use of drugs for pain relief and reduce the use of interventions in the birthing process, by stimulating the release of your body natural painkillers.  Research also shows that women find acupuncture helpful in labour.  Also, there are pressure points to try for a natural induction once your baby is considered term, You may talk to a professional about how and when to use acupressure for your labour or use online guides.

Water
This can be helpful and women may only labour and some may birth while immersed in water.   Lots of research has shown that labouring in water deep enough to cover your whole belly increases relaxation.  Where a pool is not available, many women find lying on their side in a bath relaxing or a shower, where they can control where the water makes contact with their body, like their lower back.  Many home birth groups have birth pools you can hire and some home birth midwives may have one available to use.

Self-hypnosis
Hypnosis involves a deep state of relaxation with an alert mind. There are multiple techniques that can be learnt before you go into labour. Many women find an increased sense of control using hypnosis. Your midwife or childbirth educator can usually help you find more information about hypnosis and how you can use it for your own labour.

Relaxation and Breathing techniques
These can be used right from the start of your labour and have been shown to help you relax, to relieve labour pain and give you an increased feeling of control.    Rhythmic breathing during contractions and releasing tension on exhalation can be practiced during your pregnancy and there are no known drawbacks to using this technique.  There are lots of guides available to help with relaxation and breathing techniques, as well as classes throughout New Zealand, such as hypnobirthing and calmbirth.  Or research Lamaze, the Alexander technique, and vocal toning.

Massage and Touch
Light touch or massage techniques can be used for pain relief during your labour, as they promote oxytocin and endorphins and can be useful for reducing anxiety and increasing emotional well-being.  A shoulder massage can be good to help you relax and loosen your body. Back massage can soothe pain and help you to feel loved and relaxed during early labour, especially during rest periods. Holding or rubbing your hands can be a good way for your support person/people to stay physically connected with you whilst still allowing you space during intense periods. Touch can be a powerful way of communicating positive messages of reassurance and love and can be used when doing acupressure and certain positions.  Create intimacy with your partner, feel the love of others and release your love hormones and let them assist you during your labour.

Aromatherapy
This is the use of highly concentrated essential oils or essences distilled from plants and can be used to decrease fear anxiety and pain.  A word of warning, often your sense of smell is heightened, or your preferences can be dramatically different during labour, so have your support people prepared to remove an offensive smell if needed.  You can talk to a professional about which oils might be effective in labour and how best to use them.  Clary sage is often recommended as it promotes labour and rose and ylang ylang are very female-centered oils that help you to connect to your uterus. If you feel you do not have a safe place for a naked flame, an electric aromatherapy burner can be used instead.  Or use during massage.

Homeopathy
A variety of homeopathic remedies can be used during and for recovery and well being post labour. Many midwives carry some remedies and an experienced homeopath can advise on remedies to have on hand during your birth.

TENS Machine
TENS stands for transcutaneous electrical nerve stimulation. A TENS machine consists of a hand-held controller connected by two sets of fine leads to two or four sticky pads, which are placed on your back. The machine gives out little pulses of electrical energy that reach your skin via the leads and pads. The pulses may give you a tingling or buzzing sensation, depending on the setting. The strength and pattern of these pulses are controlled by you.  Some people find this a very effective pain relief during labour.

Heat
Many woman find the use of heat helps to elevate back and stomach pain during labour. The use of hot water bottles, wheat bags and hot towels are common ways to facilitate this. It is recommended not to use directly against skin, try wrapping in a hand towel or tea towel. Using a warm cloth on the perineum during pushing can feel beneficial to some and not to others, some research suggest it help prevent perineal tears.

Rebozo
This is originally a South American woven and decorative wrap like garment that is a cross between a scarf and a shawl, varying in length.  Rebozos have two main functions, that of a garment and that as a carrying aid, often seen in baby wearing. However, a rebozo can also be used by woman during pregnancy and labour.  The gentle sifting, like a rhythmic jiggle aids tight uterine ligaments and abdominal muscles to relax and can help a baby rotate in pregnancy or labour more easily.  During labour it can also be useful to help support various positions and allow for rhythmic movements.   It can help women relax into their labour, making childbirth more comfortable and easier.  

Women/whānau who choose to birth at home believe that birth is a natural life event that should not be interfered with unless genuinely needed.  They take responsibility for their choices and educate and prepare themselves, physically, mentally, and emotionally to have the best outcome possible.  Some come to choose home birth after a direct experience of their own or being present for a birth in a hospital or stories that they have heard, that have been negative and therefore they want to avoid a hospital birth at all costs. Hospitals have their place and can be a good option if you are dealing with a high-risk pregnancy or experience a complication, however many healthy women find themselves in a cascade of interventions within the hospital birth setting.

Now we understand a little about why these birth hormones are important and what they do, we need to recognise and understand how they are disrupted, as ideally we want them to work to our advantage and to support a smooth labour and birth.

For birth to proceed optimally, our hormonal system needs to do exactly what it is designed to do during birth and that part of the brain must take precedence over the rational brain. The best way to support birth and to protect the hormonal systems from disturbances during labour is to keep birth safe, private and unobserved and free from any unnecessary interventions. The environment we labour and birth in should reflect the environment that we make love in as both require the same hormones. A quiet and private space, that is warm and dimly lit along with a sense of a feeling of no expectations allow our labour and birth hormones to work in the most advantageous way. These conditions allow a woman to intuitively follow her body’s innate wisdom and she will choose how her body moves, her instinctive sounds, her breathing patterns and positions that feel best for her and allow her to birth her baby in a way that feels natural to her.

Some suggestions on how to keep birth undisturbed and avoid a hospital transfer

Choose your maternity caregivers and birth setting wisely – Birthing at home is a safe option that supports and enables our hormonal system to function efficiently. Also choosing a midwife who you trust and who is comfortable using less technology and medical interventions is important. Choosing a midwife who believes in your body’s ability to birth is key in avoiding an unnecessary interventions, however, should the need arise, you can always transfer to a hospital. Remember feeling safe is subjective and is different for every woman and it is your own perception of safety that matters.

Choose your labour support team carefully – select people who make you feel safe, whom you trust and love. People who will not take offense if you do not call them or if you ask them to leave. People who trust in your ability to give birth naturally and who will not project their fears onto you.

Take the time to research all the options that you have available to you, and see which tests and procedures you want to partake in and which ones you don’t. Think carefully about what you would do with the information and how this may influence your pregnancy and birth. For example, ultrasound scanning can be used to estimate the size of a baby, but the accuracy is poor. Some women have found themselves succumbing to further interventions because their baby has been identified as too big or too small, when in reality the baby is born of average size, Discuss options with your midwife, as they should be able to offer you a wealth of information and make decisions that feel right for you.

After doing some research you will have an idea of how you’d like things to go during your labour and birth. You should discuss this with and may want to create a written birth plan for everyone involved in the birth, so they are aware of how you visualise your home birth. Some people do not like things to be so structured and are willing to be more fluid and go with the flow and trust the people around them to honour their thoughts and decisions as discussed previously.

As many women feel like they lose their sense of independence and control when it comes time to give birth it is essential that you learn about informed consent and know that at the end of the day, the final decision is always yours. Be open and honest when communicating with your midwife, you are a team there should be no hierarchy of power.

Think positively and be confident that you will have a safe and undisturbed birth in your home. Use positive affirmations to assist you in visualising this. Immerse yourself in a positive birth community and empower yourself with natural birth information. Women find that attending natural birth classes is a useful way to practise specific techniques for their birth and meet like minded people.  Avoid negative stories, or stories that may induce fear, some people embellish their experience to make it more interesting and dramatic to engage listeners, also seen on television and movies.  If you want to overcome particular fears or blocks, you should educate yourself and use techniques to do so.

Create your own privacy and birth environment in your home. Create your birthing environment at home the way you want it to be and what you find comfortable and relaxing, it needn’t be flashy or expensive, but having the basics at hand and specific to your needs and desires will help. By controlling your sensory input you can close yourself off to what’s going on around you. Try closing your eyes or wearing an eye mask. Ask those attending to reduce their words to a minimum and speak quietly, listen to music or any relaxation/mediation soundtracks you have used during pregnancy. Use smells that are familiar to you.

Leaving your home and moving to an unfamiliar environment is usually one of the first disturbances of labour, there is usually a shift in consciousness, and it can slow or even stop contractions by disrupting your labour hormones. Therefore if you plan on leaving home, go to the point of no return. – This is the point during labour, where external disturbances will not slow labour down. This usually occurs when there is an alteration in consciousness and our rational brain subsides and our instinctive brain takes over, so things such as reciting your phone number become difficult.

One of Home Birth Aotearoa’s primary goals is to support women to have the birth of their choosing. Sometimes, despite all best efforts and robust conversations about the benefits and risks of a given situation, transfer to hospital or a caesarean section may be inevitable and the decision may be made during pregnancy or while in labour. This guide will help you navigate this process with the best tools at hand to make your birth an empowered one. About one in three babies in New Zealand are now born by caesarean section.  Some of these births are planned and others will happen as an emergency procedure. Caesarean section is now a common experience for many families.

While home birth families experience lower rates of caesarean section than the rest of the population, there are still some times when this intervention is inevitable. Although caesarean section is practically a routine way of giving birth today it is still a surgical procedure.  Yet there is no reason birthing inside the operating room has to automatically preclude the creation of a humane, kind, affirming and celebratory life event. Because we’ve lagged behind in recognizing this need to humanize surgical birth, caesarean sections are often unnecessarily traumatic for both mother and baby, and sometimes other family members.  It may surprise you that even hospital staff are vicariously traumatised. Some of the negative effects of caesarean section are unavoidable, and some of the negative physiological and psychological effects are yet to be discovered. Even still, with what we know now, we could do better in improving the experiences of mothers who meet their babies for the first time in the operating room.

If a caesarean section is something that you are considering, you should definitely look into a gentle Caesarean and discuss with your midwife. It is aimed to be more natural and intimate than a traditional caesarean section. This is because the baby is delivered much slower. The baby’s head is delivered, and then only slowly is the rest of the baby’s body delivered before the baby is handed to the mother. Depending on the situation and number of staff in theatre, your midwife will most likely need to advocate your wants on your behalf, therefore it is good to include these in a birth plan.

Tips for a Gentle Caesarean Section

Be awake, if possible
Except in the most pressing of emergencies, most caesarean sections can take place safely under regional rather than general anaesthetic. Although daunting to consider, being awake offers many advantages to you and your baby.  Most hospitals will allow one support person to stay with you if you have a spinal or epidural anaesthetic, in addition to your own midwife.  Your midwife, advocating for you, can help you get the best caesarean experience possible, so make your wishes known to her.  It can pay to think a little about what is important to you, and the following steps can help.

Tell the surgical team if you want to see your baby emerging.
The team often puts up a drape near your shoulders to separate the spaces between the surgical side and the anaesthetic side of things.  They may think you or your support person will be squeamish, but that’s largely a judgement call they are making and a relic of days gone by when all caesarean sections were done under general anaesthetic.  Seeing your baby emerge can especially help home birthing families because one of the reasons for home birth is to make sure there aren’t important gaps in baby’s life that strangers experience instead of the family.  It can be annoying, rude and disturbing when others get to see (and comment) on their newborn before they do.

Tell the surgeon you want to discover the baby’s gender in the way you had planned.
I don’t know of any family who wanted the obstetric staff to make the big announcement.  If your plan was for your partner to be the one to tell, that can still happen.  If you were going to discover this together yourselves, that can still happen too.

You can ask to touch your baby first.
It’s lovely if you are the first one to touch your baby.  When you are anesthetised for surgery, many women describe a surreal experience until the baby is in their arms. Touching the baby is possible, over top of the drapes.  The surgeon may worry about their sterile field, but as long as you don’t touch the surgeon, and stick to the baby, it’s all good.

Consider claiming the theatre space with music.
Some families bring in a special piece of music that can be played as the baby is born.  It’s another way to claim the space as your own.

Take photos
Most teams don’t mind photos being taken of various aspects of the birth, as long as hospital staff aren’t the focus of the pictures. Yes, there is blood, and often the best pictures are black and white shots (which, owing to the miracle of digital photography, can be done after the fact). Consider designating a photographer other than your support person so that he or she can focus on other things.  Tell the photographer to take as many photos as possible.  You can always delete them, but you can’t turn back the hands of time to get them if they haven’t been taken in the first place.

Bring your own baby hat
Operating theatres are often very cold and the baby may get “hatted” to prevent the loss of heat.  Bring a special one to put on baby. That hat will feature in the first newborn pictures.

Delay cord clamping.
Delayed cord clamping is very important, yet some surgical teams are in a rush to clamp the cord, usually because of concerns over bleeding. The team can facilitate this by changing the surgical technique slightly. Let your obstetrician know that delayed cord clamping is important to you, and ask if the hospital has a policy to facilitate this procedure.

Skin to skin in theatre
Skin to skin is a beneficial practice, perhaps a crucial one, for newborns, particularly the caesarean born, and many hospitals have position statements that support it, at least in theory.  Skin to skin helps the newborn transition to life outside the uterus, and the effects can be far reaching in terms of permanent changes to the physiology of the newborn.  The mother’s body continues to be the ideal baby’s habitat after birth.  We want babies to stay with their mothers to become colonized with her “safe” bacteria rather than hospital flora, and mothers in particular (rather than their partners, who are a good substitute but not quite as good as the mother).  It is the mother who provides, through breast milk, an accessory immune system for the baby.  Mothers need to be exposed to everything the baby is exposed to in order to help baby defend against any challenges the environment will offer.  Staff often feel that mothers are not “up” to skin to skin however, you don’t need to do much other than lie there with baby snuggled on you, bare skin to bare skin.  Your midwife, or one who is designated to help with the baby in the operating room, can help make skin to skin happen even as the surgeons are sewing you up.

Find out before you leave the hospital if you can VBAC, and get your hospital notes.
It might be the last thing on your mind, but the best time to ask if a vaginal birth will be possible for your next baby is now.  That’s because sometimes the hospital does a bad job of documenting events at a birth, and a couple of years down the track when you really want to know, it can be difficult to chase down the truth of events that aren’t recorded.

Bless yourself
Though many families have been down this path, it is still incredibly hard.  The physical reality of caesarean section is huge.  The physiological reality of caesarean section is huge.  These are traumatic events, even as they can be filled with joy at the same time.  Be easy on yourself.  Plan for extra support and self-care.  When you are home, consider a re-birthing ceremony, and have a healing baby moon.

This segment Gentle Caesarean was written by Alison Barrett BSc, MD, FRCS(C), FRANZCOG. Dr. Alison Barrett has worked as a specialist obstetrician and gynaecologist for many years in both New Zealand and in Canada.

One reason people choose home birth is because they can avoid being contaminated by the microbiota of ill people and exposure to hospital super bugs. The flora that your baby receives upon birth will be key to their lifelong health. Protecting your baby’s ‘microbiome’ is one good reason for considering home birth.

We are the hosts to many microscopic organisms; bacteria, fungi, parasites and even tiny crustaceans, who make up an entire invisible world within and upon us: the microbiome. The microbiome is crucial to our health; it functions like a hidden organ of the body. Our microbiome is unique to us, mine differs from yours. Within our bodies, our microbiome even differ depending on which part of the body we are looking at, so there are different combinations of species that live in our gut compared to our skin, in our armpits versus up our nostrils. The organisms of each microbiome are vast in number. There are more organisms living on each one of our bodies than there are human beings living on the planet earth.

Part of the reason we couldn’t and didn’t discover this world right under our noses was because we used to have to rely on capturing or culturing organisms to tell they were there. But now, with DNA and gene sequencing techniques, we don’t have to rely on growing the bugs that we host (and creating the sometimes tricky conditions for bugs to grow). These new techniques have allowed us to debunk another myth: that babies occupy a sterile world inside the uterus. There is evidence that mothers do transfer bacteria to their unborn babies, but usually these bacteria are also ones that mothers have checked out and tamed. It’s like mothers make sure the friends that come over to play with her foetus aren’t going to be psychopaths. After birth, all new bacteria that the baby is exposed to for the first time undergo a similar maternal vetting process.

Firstly, as babies emerge from the vagina, they are slathered with vaginal organisms, including lactobacillus, selected to live in the vagina over millions of years of evolutionary time. Since lactobacillus literally means milk bacteria, it’s no coincidence that lactobacillus’ preferred diet is breast milk. When we feed our babies our breast milk, we are feeding these bacteria too. Additionally, and hopefully, babies born near their mother’s anus receive heirloom species from the mother’s gut flora. In other words, mum’s poop is the optimal starter for the baby gut microbiome. Breast milk, lactobacillus, and heirloom gut species together help grow the right microbiome; one that the mother’s immune system is already accustomed to developing and defending. It is, one investigator stated, as if “mothers are recruiting another life form to babysit their babies” (L, 2012 Sep;22(9):Epub 2012 Apr 18.).

Good bacteria are essential to our health, in ways we are just discovering. These bacteria supply us with genetic capabilities we don’t have, providing us with essential nutrients and substances we can’t otherwise obtain. For example, we get Vitamin K almost exclusively from our gut bacteria. There is evidence that babies born by caesarean section, or babies fed infant formula, have a different microbiome than babies born vaginally and exclusively breast fed. This difference can last for the rest of their lives. Because of this some researchers, including Dr Rob Knight of the University of Colorado, are studying the effects of inoculating caesarean section babies with maternal vaginal flora. Some mothers have even suggested taking matters into their own hands, so to speak, to ensure that their babies are colonised in the way nature intended.

Caesarean Sections and the Microbiome

Delayed cord clamping and skin to skin add to the picture of ensuring a healthy microbiome. Keeping the cord attached to baby means that baby stays close to mum, and not exposed to the bacteria of others. These optimal practices have other benefits of their own, of course, and they each probably have benefits we have yet to discover.

Completing the picture is birthing at home. Home is, after all, most likely to be where your microbiome is most comfortable. Hospitals are often places where bacteria have learned to be resistant to antibiotics, in fact, nosocomial or hospital acquired infections are a major source of morbidity and mortality. As we discover more about the organisms that keep us healthy we shouldn’t be surprised to also learn that creating the conditions for ensuring an optimal microbiome may include birthing at home. Interesting article on this topic here

This segment The Microbiome was written by Alison Barrett BSc, MD, FRCS(C), FRANZCOG. Dr. Alison Barrett has worked as a specialist obstetrician and gynaecologist for many years in both New Zealand and in Canada.