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Birth Partner 5th Edition: A Complete Guide to Childbirth for Dads, Partners, Doulas, and All Other Labor Companions Paperback – October 9, 2018
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From the Publisher
How Long Will Labor Last?
It is impossible to predict how long any particular labor will last. A perfectly normal labor can take between 2 and 24 hours following the hours or days of prelabor.
Presentation refers to the part of the baby, top of the head (the vertex), brow, face, buttocks, feet, shoulders that is lowest in the uterus. The vertex almost always presents first; problems occur in delivery if any of the others present first. Position refers to the placement of the presenting part within the mother’s pelvis. The most common positions are:
- OA (occiput anterior): The back of the baby’s head (the occiput) points toward the mother’s front (anterior).
- OT (occiput transverse): The back of the baby’s head points toward the mother’s side (transverse).
- OP (occiput posterior): The back of the baby’s head points toward the mother’s back (posterior).
Although babies can and do change position during labor and during the pushing (second) stage, at birth the OA position is much more common than OP or OT. When the baby is in the OP position in labor, with the back of his head toward the mother’s back, labor is sometimes backache. There are many other reasons for back pain in labor, however (see page 185), and you should not assume the baby is OP just because the mother has back pain, prolonged, and the mother may experience intense
Many factors influence the length of labor:
- Whether this is a first or later baby.
- The condition of the cervix (soft and thin or firm and thick) when progressing contractions begin.
- The size of the baby, particularly the head, in relation to the size of the mother’s pelvis.
- The presentation and position of the baby’s head within the mother’s body.
- The strength and frequency of the contractions.
- The mother’s emotional state, if she is lonely, frightened, or angry, she may have a longer labor than if she is confident, content, and calm.
Labor Progresses in Six Ways
A woman makes progress toward birth in the following ways. Note that significant dilation does not take place until step 4. The first three steps usually occur simultaneously and gradually over the last weeks of pregnancy.
1. The cervix softens (ripens). While still thick, the cervix, through the action of hormones and prostaglandins, softens and becomes more pliable.
2. The position of the cervix changes. The cervix points toward the mother’s back during most of pregnancy, then gradually moves forward. The position of the cervix is assessed by an exam and is described as posterior (pointing toward the back), midline, or anterior (pointing toward the front).
3. The cervix thins and shortens (effaces). Usually about 1½ inches (or 3 to 4 centimeters) long, the cervix gradually shortens and becomes paper-thin. The amount of thinning (effacement) is measured in two ways:
Percentages. Zero percent means no thinning or shortening has occurred; 50 percent means the cervix is about half its former thickness; 100 percent means it is paper-thin.
Centimeters of length. Three to 4 centimeters long is the same as 0 percent effaced; 2 centimeters long is the same as 50 percent effaced; and less than 1 centimeter long means 80 to 90 percent effaced. Be sure not to confuse centimeters of cervical length with centimeters of cervical dilation!
4. The cervix opens (dilates). The opening (dilation) of the cervix is also measured in centimeters. The measurement is estimated by the caregiver who inserts two fingers through the cervix, spreads the fingers to the edges of the cervix, and estimates how far apart (in centimeters) the fingers are; it is not an exact science. Dilation usually occurs with progressing contractions, after the cervix has undergone the changes just described, but it is common for the cervix to dilate 1 to 3 centimeters before the woman has Positive Signs of labor. The cervix must open to approximately 10 centimeters (almost 4 inches) in diameter to allow the baby through.
5. The baby’s chin tucks onto his chest (this is called flexion) and his head rotates. The rotation makes it easier for the baby to pass through the birth canal. (Sometimes, especially if the head is large, it must mold before it can rotate. This means that the head changes shape, becoming longer and thinner. Molding is normal, although some babies’ heads look somewhat misshapen for a day or two following birth, after which they return to a round shape.) The most favorable position for birth is usually the OA (occiput anterior) position; see page 43 for information on other positions.
6. The baby descends. The head continues to mold as necessary to fit and descends to the outside. The descent is described in terms of station, which (a) tells how far above or below the mother’s mid-pelvis the baby’s head is (or buttocks or feet, in the case of a breech presentation; see page 190); (b) is measured in centimeters; and (c) ranges from minus 4 to plus 4. A zero station means the baby’s head is right at the mother’s mid-pelvis. Minus 1, 2, 3, or 4 means the head is that number of centimeters above the midfloatingpelvis. The greater the plus number, the closer the baby’s head is to the outside and to being born.
Some descent usually takes place before labor begins, especially with first-time mothers. When the baby drops, it settles into the pelvis to about minus 2 or minus 1. Most of the descent occurs late in labor.
Steps 4 through 6 (dilation beyond 2 to 3 centimeters, rotation, and descent) cannot take place until the first three steps are well under way. In other words, a cervix that is firm, thick, or posterior won’t open. It simply is not ready. And a baby won’t rotate and descend significantly until the cervix is open. For many women the first three steps take place imperceptibly and gradually in late pregnancy. For others they take place in a few days, with strong or even painful non-progressing contractions, which are referred to as prelabor contractions.
In early labor, one of the important jobs of the birth partner is to time contractions. Since changes in the length, strength, and frequency of contractions are the all-important hallmarks of true, progressing labor, it is a good idea for you to (1) know how to time correctly and (2) keep a written record. Then, when you call the mother’s caregiver, you will have accurate and concrete information to provide.
You may use a smart phone or computer with an application for timing contractions. There are many available. Search the Web or app store for labor contraction record, or something similar. The mother indicates the beginnings and ends of contractions and you or she taps the screen or presses a key. The smart phone keeps track of duration and frequency. You can enter other information like that shown in the Comments column in the table on page 55. Keep track of five or six in a row, to record the contraction pattern. Then you may wait until the contraction pattern seems to have changed. Time five or six more, and resume timing when she says the contractions are clearly stronger. Continue in this way until it is time to call the hospital.
About the Author
Penny Simkin, PT, is a physical therapist, childbirth educator, doula, and birth counselor. She is nationally recognized as a premier authority on childbirth, having helped 9,000 expecting women and birth partners in childbirth and attended hundreds of couples though the birth process. Simkin is a prolific author and serves on more than 10 different consultant and editorial boards, including the journal Birth: Issues in Perinatal Care, The International Childbirth Education Association, and The Seattle Midwifery School, where she also provides training for doulas and lectures to students. She has written myriad books, journal, and magazine articles. Simkin is also co-founder of DONA International (formerly Doulas of North America) and The Pacific Association for Labor Support. In addition to providing childbirth education, birth counseling, and labor support, Simkin travels extensively throughout the country, lecturing and presenting at conferences and workshops. For more information, please visit Simkin’s website at pennysimkin.com.
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While I understand that the 5th edition is welcomed by a small percent of the population, I believe that a book that is intended to assist expecting families should contain the same terminology as professional literature, which contains the terms "woman," "she," and "mother," not "person/parent."
I believe the best option might be to continue to publish the 4th edition along with the 5th edition, which should have some kind of designation regarding intended audience.
We did not use a doula for our labor and birth. I was her support and along with the great nursing staff, we did great. I felt confident in my ability to help her and we used several of the pain mitigation techniques offered in the book. I found I did not have to reference the book more than a couple times during the whole event as I'd read through it and was prepared ahead of time. My wife was able to delivery vaginally with no epidural or other pain medication. I do find that the book is very pushy for getting a doula, which I understand as Penny is a certified doula who has helped establish a strong doula network within the U.S.
Each chapter/section talks about mama and baby first, then how the birth partner can help, and finally how a doula can help even more. For those people thinking of possibly getting a doula, the last bit may be very useful in order to help you better understand how one could help. If you know for sure you do not want one, you can read it as a way for the birth partner to help even more.
The book itself is very nicely organized by chapter and features small sections at the end of each chapter that is a summary of what the chapter talked about. These sections have a grey border, which makes them very easy to find while flipping through the book. This makes them very easy to find later while in labor and delivery, but I also found a couple small sticky notes in certain sections with subjects written on the notes, makes it even easier.
No matter if you plan on a hospital birth, home birth, with or without pain medication, I highly recommend you read through this book. Even if it isn't the first child, if you aren't feeling confident about being a good support for mama and baby, read through it and you'll know exactly what to do.
I’m not trying to say the position of doula isn’t useful, or that no one should get one. It just seemed like this book expresses that without a doula your birth will be horrible and painful and you won’t have your music. Or you can get a doula and with the added person standing taking pictures, holding your water cup, and playing calming music (for a small fee of....) you can have a good and memorable birth of all your children.
Just not buying it.
The book goes into explicit but easily digestible detail of pregnancy, different types of labor, the types of support one can offer in labor, what you'll encounter in a home birth vs a hospital birth, basic baby care after the birth, and caring for the mother throughout the entire process.
It also covers the different styles of birth from home births to hospitals and natural labor to different medications that can be used. The tone of the book is really open and doesn't push any agenda of which way is better over another. Instead, pros and cons are laid out for each, and the book is really educational so that the mother and partner can make informed decisions. It's very pro-mother and its theme is that the mother's choices are the right choices for her.
As a co-mother, I found the book to be inclusive of different support partners, as well.
The book also offers a ton of resources with a number of links to videos, references to websites and other books.
It's really a must-have read.
Top international reviews
I liked it because of the amount of detail about everything to do about child birth. I had zero intention of making a birth plan. (Plan was deliver the baby however our doctor thought necessary to keep us safe). But this at least I could be informed about all the choices I might need to make during labor, and what the positive and negative outcomes could be. By having this knowledge I think I was definitely more prepared, and less nervous for labor and birth. I really liked all the charts in the book, helped compare everything you read (like a chart on pain medication).
Highly recommend for new parents, I'll be refreshing my memory with this book when I need it again.
It is structured in a way which allows you to read it from beginning to end, no matter in which stage you currently are, and has a good table of contents which helps you find the relevant parts again when you need them. There are good checklists in the beginning to get you started on what you actually need to do before the birth, then it gives you a very good model of the kind of things you need to expect on emotional and other levels. It provides good, detailed descriptions of what's going on, and most importantly, it offers a lot of very good birth stories to take your mind off all the horror stories people are bound to keep throwing at you.
The helpfulness of this book seriously can't be overestimated!