Factsheet – Managing labour: Mood, Mobilise and Munch (part 1 of 3)
Professor of Midwifery and Maternal Health, Birmingham City University
Birth (reproduction) is a physiological process that shows we are alive, other signs of life include eating (nutrition), excretion and breathing (respiration). However, it would seem that we struggle more with birth than any of the other elements of life.
In 2017/18, 52.2% of women commenced labour spontaneously, with 57% of women giving birth spontaneously1, as opposed to requiring either instrumental or caesarean interventions for birth. This suggests almost half of births require additional external intervention, giving rise to the question: What can we do to support our bodies doing what they was designed to do and give birth in the healthiest way possible?
Although there are no guarantees for an easy labour this factsheet series explores three keys to physiological labour where potentially harmful or unnecessary intervention is kept to a minimum. They are managing your mood, mobilising prior to and during labour and munching throughout labour. This fact sheet looks at mood- how to get into the best frame of mind for labour to support normal physiological processes.
Link to Mood Factsheet: This article
Link to free flow article: How to have a positive birth
What we know
Although it sounds obvious to say that our mood influences how we labour, it is harder to think about how we can control our mood whilst undertaking something that is as difficult as labour. Labour is just as it says – hard work. This is because it is usually a long-awaited event with an unpredictable start. A woman is given a due date but often labour does not start for some time after this date. Then when it does start, the “latent” phase or early labour, characterised by irregular contractions may carry on for several hours or even a few days. This on its own can make a person anxious and leaving the family feeling impatient.
Due to bodily discomfort of these irregular contractions, often accompanied by a lack of sleep and not knowing quite when the established labour event will begin, understandably may lead to feelings of anxiety. When people are afraid, their bodies release adrenaline known as “the fight or flight hormone”. This causes blood flow to be diverted to our arms and legs ready to fight or run away thus reducing blood flow to the uterus where it is needed for effective contractions. On a subconscious level, therefore a woman may feel it is unsafe to labour so her body, diverted by the anxiety hormone of adrenaline will not labour effectively leading to an increased risk of intervention occurring.2,3 The key is to find ways of reducing anxiety and managing your mood.
There are many ways to manage anxiety, different people will find the way that is best suited for them. One way, as discussed in part two of this series is to exercise during the antenatal period which will help to reduce anxiety in labour.4 Also discussed in part two, when a person is in an upright position and has freedom to move as they wish, they may feel in more control which reduces their anxiety. Using water, not only helps manage pain but is also found to give women a feeling of being in control, in part due to the physical barrier the pool creates around the woman. Another approach, discussed in part three is to eat a little of what you fancy during labour, which will foster feelings of being in control as well as adding energy to help you keep going emotionally, as birth can be a long strenuous process.
Although there are many elements to anxiety, when looking at information researchers have found; the key to managing your mood centres on birthing women feeling in control.5,6 This can be about you controlling what your health professionals are doing (choices about what care you get), and knowing you can participate in this conversation. In fact, most midwives welcome this. Doing what you feel makes you comfortable (such as mobilising and munching), and feeling that you are in control of your contractions no matter how uncomfortable is beneficial.7
Other ways of feeling in control may include bringing in items from home that make you feel more relaxed. This might include a pillow to make you snug and more “at home” or diffuser sticks to make the room smell more like home (smell, especially in pregnancy, is very powerful).
Finally consider who you would like to be with you during this all-important time. This can be anyone of your choosing, partners often want to be present and this is fine, but also think of someone who is nurturing to you. There are many studies that tell us that the person with you during labour makes the most difference to the outcome.8
What we don’t know
Although there is plenty of anecdotal evidence, the 2018 Cochrane review that pulls together all the research evidence about relaxing in labour concluded that at present we don’t have strong evidence around mood management but suggested that relaxation, yoga and mindfulness may be helpful in labour.
There has been much made of using a written care plan to support you manage your labour however research around this is generally of low quality, and although in a recent review suggested that making a birth plan improved a woman’s experience of birth, the evidence was not strong enough (statistically significant) to make a robust case.9
It is very difficult to study something as complex as mood during labour because there are so many factors that make a difference, with each person responding to stress and labour in different ways.
Mothers and families: how to use the evidence
- Plan and prepare the person who will support you during birth, so they know what you want and need
- Ask whether you can have care from a small team of midwives so that you are known by the midwife – this is called Continuity of Carer. If this is not possible think about how you will communicate your wants and needs to the midwife who will look after you during labour. Don’t be afraid to speak up about those things, as most midwives want to be supportive.
- Prepare as much as possible for labour, try to visit the place you plan to give birth, this will help you feel for familiar with your surroundings. Including finding out how the bed works so you can push it to the side of the room and use it to lean on rather than climbing into.
- Speak to your midwife or attend antenatal classes to get a good understanding of how your body works, what sensations you will feel, and how long each stage is likely to take so that you are not taken by surprise.
- Have a plan for how you will manage the discomfort of labour with a plan “a” and “b” if the first one does not work, at the same time be prepared to “go with the flow if your birthing process does not go as expected so that you don’t become upset or disheartened.
- Plan and pack edible treats for you to eat while in hospital as this will bring relief and can act as a “reward” to keep you going.
- When coming into hospital plan ahead, about what you would like to bring that will give you comfort and control.
- Making a written birth plan.
Midwives and birth workers: how to use the evidence
- Support women using the information given above, particularly support them in thinking through their personalised care factors and what their own approach will be, rather than once they are in labour.
- I have been a midwife for 30 years. I have always been very keen on supporting women to have choices and feel in control. One of the things I always did was to give a commentary of what I was doing/finding when doing a vaginal examination. I always thought this was helpful to women. Recently, a woman who I had been caring for over several hours, and had built up a nice relationship with, said “I wish you wouldn’t talk while doing the vaginal examinations – I don’t like it.” Never did I imagine this would be the case. Of course, I stopped immediately and now I always ask women what they prefer.
- As you know, it is always best for women to stay at home as long as possible, usually, women feel more in control and manage early labour better at home than in the hospital. However, there are times when it seems anxiety is holding the woman back. Having observed and cared for two quite young women like this recently and feeling anxiety was holding them back I took a different tack. I sat with them, offered to stand in for their mums, as their mums could not be there due to COVID 19. I sat with them, fed them whilst building a trusting relationship. Later we ‘slow danced’ round the birth room to encourage movement and used water to help manage their pain. It was surprising how quickly they then progressed in labour. The reason for this story is to show how a mixture of relationships and the women now being in control and managing their mood made a difference to their experience.
Links to other resources
Continuous support for women during childbirth Cochrane Review 2017
Relaxation techniques for pain management on labour Cochrane Review 2018
Intrapartum care for healthy women and babies – Clinical guideline [CG190] Care during labour
Royal College of Midwives – Midwifery care in labour guidance for all women in all settings
Milli Hill: Give Birth Like a Feminist
Penny Simpkin: The Labor Progress Handbook, early interventions to prevent and Treat Dystocia fourth edition, Wiley Blackwell
Rhea Dempsey: Birth with Confidence
Lamaze International (2009) Healthy Birth Practice 4: Avoid interventions that are not medically necessary. (adapted from The Official Lamaze Guide: Giving Birth with Confidence).
NHS Digital. Maternity Services Monthly statistics Dec 2019, experimental statistics, 2019.
Erkaya R, Karabulutlu O, Calik KY. Defining Childbirth Fear And Anxiety Levels In Pregnant Women. Procedia – Social and Behavioral Sciences 237 ( 2017 ) 1045 – 1052. Spain: Elseveir; 2017. p. 1045-52.
Adams SS, Eberhard-Gran M, Eskild A. Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery. BJOG 2012; 119(10): 1238-46.
Domenjoz I, Kayser B, Boulvain M. Effect of physical activity during pregnancy on mode of delivery. Am J Obstet Gynecol 2014; 211(4): 401.e1-11.
Cheung W, Ip W, Chan D. Maternal Anxiety and feelings of control during labour: A study of Chinese first time pregnant women. Midwifery 2007; 23: 123-30.