To eat or not to eat…That was the question for families planning a hospital birth.  When you are laboring at home or a birth center, you have the freedom to eat as your appetite dictates.  If you choose to have a hospital birth, you are at the mercy of your doctor’s orders and the nurse’s interpretation of the hospital protocol.  

"Most healthy women can skip the fasting and, in fact, would benefit from eating a light meal during labor, suggests research being presented at the ANESTHESIOLOGY® 2015 annual meeting. Improvements in anesthesia care have made pain control during labor safer, reducing risks related to eating, researchers note."

ASA Press Release, "Most healthy women would benefit from light meal during labor", October 24, 2015

For other reading,  HERE is some research I had found before this 2015 press release to make the case for eating and drinking in labor (in case you want to do more poking around the subject).

Science and the ASA catch up to Dr. Bradley:

"The research suggests that the energy and caloric demands of laboring women are similar to those of marathon runners, Harty said. Without adequate nutrition, women’s bodies will begin to use fat as an energy source, increasing acidity of the blood in the mother and infant, potentially reducing uterine contractions and leading to longer labor and lower health scores in newborns. Additionally, the studies suggest that fasting can cause emotional stress, potentially moving blood away from the uterus and placenta, lengthening labor and contributing to distress of the fetus."  

From the press release:

"Researchers said aspiration today is almost nonexistent, especially in healthy patients. In the United States, there was only one case of aspiration associated with labor and delivery between 2005 and 2013, involving a complicated case of a woman who was obese and had pre-eclampsia (a precursor to eclampsia, or high blood pressure that can lead to seizures), according to the American Society of Anesthesiology’s Closed Claims Project database. Researchers also noted that no cases of death due to aspiration were reported in the United Kingdom between 2000 and 2005, compared to 1.5 cases per 1,000 during the 1940s. They say this is likely due to advances in anesthesia care, including increased use of epidurals and spinal blocks in place of providing anesthesia through a mask over the nose and mouth. Before these improvements, women were more likely to need a tube placed in the windpipe for breathing, which potentially increased the risk of aspiration." 

What the ASA recommends:

"A light meal could include fruit, light soups, toast, light sandwiches (no large slices of meat), juice and water. Most women lose their appetites during very active labor, but can continue to drink fluids such as water and clear juices, researchers said." 

- Honey sticks.  According to honey.com, “Honey is also a rich source of carbohydrates, providing 17 grams per tablespoon, which makes it ideal for your working muscles since carbohydrates are the primary fuel the body uses for energy. Carbohydrates are necessary in the diet to help maintain muscle glycogen, also known as stored carbohydrates, which are the most important fuel source for athletes to help them keep going.” [2]

- Trail mix.  You get the nice variety of nuts, dried fruits and if you want, candy, in one bag.  I found myself picking out my favorite nuts and fruits and snacking on them – literally one or two at a time – as we got into the active phase of first stage labor.

- Protein bars or chews.  Look for bars that are low in carbs and added sugars –the key is to provide an energy boost without an energy crash afterwards. We have had students that use the “PowerBar” brand Energy Bites, as well as Gel Blasts that are bite size energy foods.

- Popsicles.  While working hard in labor, a popsicle can be refreshing.  To prevent an energy crash, look for a brand that uses natural fruit as a sweetener instead of added sugars.  Added bonus: you can also push it against the top of your palate to stimulate oxytocin production.

- Applesauce cups.  Provide potassium along with a little protein.  The nice thing about applesauce is that while some people prefer them cold, they don’t need to be refrigerated.  Again, look for naturally rather than artificially sweetened sauces.

- Soup or clear broth.  Campbell’s came out with the “Soup at Hand Cups” that are single serve, portable and microwaveable.  They were a God-send during our third birth.  The nurse didn’t want me to eat “just in case”, but she was okay with me drinking – hence, I could drink my meal and stay nourished through our 34 hours at the hospital.

The material included on this site is for informational purposes only.

I am going to direct you to THIS article about how oxytocin helps to reduce stress and promote peace.  It's no surprise that oxytocin is the same hormone that is released when we make love, arguably a great stress reliever and a promoter of peace for couples.  A lovely consequence of making love when the timing is right: welcome, baby, some 36+ weeks later!

Breastfeeding:  If you have an older sibling who is nursing, you can nurse them during labor.  Nursing stimulates the production of oxytocin, so I encourage you to be mindful of any contractions it stimulates.  You do not want to trigger an early labor, so pay attention if you feel a pattern developing and it’s not time for baby to make an appearance just yet.

Touch: one of the cornerstones of The Bradley Method® is relaxation.  Among the 11 specific relaxation techniques that we teach during the course, two of them are massage and stroking.  Even if a mother does not want to be spoken to, a Coach can use those techniques.  If she doesn’t want that either, the simple act of holding her hand is listed as a way to boost oxytocin.

Daydream:  Another relaxation technique we teach is related to daydreaming.  We ask coaches to recount a past experience or a future dream that makes mother feel like she is in her “happy place”.  It might be a trip, an experience, dreams you have about your life as a family together...anything that is calming, encouraging and would elicit a smile.

Pleasant smells:  This one has the added benefit of paying dividends at your birthplace.  One of the suggestions we make in Bradley™ class is to eat your favorite meal when you think you might be in labor.  The other one is baking some yummy treats to share with your care providers.  Hopefully both of those things will generate smells that you welcome in labor.  Either way: you are producing oxytocin, mama is well fed if it’s the beginning to have energy for the duration of labor, and your care providers get treats.  We found that feeding them kept them happy and that always made for positive birth experiences for us.

Music:  Mamas or Coaches can take the time to generate a play list to use in their birth space.  I have seen couples use a music app to choose the music for them in labor – it saved them from the planning/organizing time at the outset while still providing the music that was soothing to mama.  Find something that works for you and remember to put it on your packing list so the music makes it to your birth space. 

P.S. Doula and Music Therapist Laura Pruett offers playlist creation as a stand-alone service or as part of her doula service.

The material included on this site is for informational purposes only.

Carnival of Natural Mothering
April 2014: What You Wish You Knew

Remember when you got your first positive pregnancy test? What do you wish that woman knew? Write a letter of love and encouragement to that awesome mama just starting her journey.

Birth: Find a comprehensive childbirth class that prepares you and your coach for a positive birth experience.  Connect with the ICAN group in your area and learn how to avoid a primary cesarean, because an unnecessary one can be heartbreaking.  Read up on placenta encapsulation and the postpartum period.

Breastfeeding and Parenting: Find a group of women and/or families to build your village.  The best lesson I ever got was to ask questions and take advice from the parents that are already doing/have done what you want to do.  If you want to breastfeed, don’t get advice from someone who made a different choice.  Connect with breastfeeding mothers at La Leche League or a breastfeeding support group.  If you want to babywear, don’t seek out a person who is always pushing a stroller.  Connect with a babywearing group in your area, or find a group online.  If you want to practice gentle parenting, read up on attachment parenting, and in this day and age, you can connect with the experts online.  Two of my favorites are Dr. Laura Markham and L.R. Knost. 

 

Maternity Leave: Are you going to work outside the home after a maternity leave?  Connect with the women who have made that choice and have the breastfeeding/parenting relationship you want with your child.  As far as I know, there are no support groups for that.  I have a cadre of students who have breastfed/are breastfeeding and practice attachment parenting while working out of the home full-time.  Please feel free to contact me to connect with them – several are willing to share their stories and mentor new mothers.

The decisions you can make and be in control of:

Eating a whole food, balanced diet: as much as possible, skip the processed foods.  Here’s an illustration: if your great-grandmother wouldn’t recognize it as food, do not eat it. Or, try this one: if it has more than ten ingredients, or more than one you cannot pronounce without concentrated effort, then put it back on the shelf. Check out our posts on nutrition HERE.

Exercise every day: even 10-20 minutes of cardio is better than none.  You are going to be part of an athletic event...train for it intentionally. Engage in both stamina-building and pregnancy-specific exercises to equip you for a stronger pregnancy and birth.

Avoid harmful substances: back to all those things you cannot pronounce.  Pregnancy is a great time to go green…one change at a time.  Start by looking at your personal care products…then your kitchen…then your cleaners (both at home and in your school and/or workplace).  Commit to yourself and to your baby that once a month, you will make a change that will make just one more thing in your life non-toxic.  By the time you are holding your Sweet Pea, there are at least 7-8 changes that are now healthy habits.

Choose the right care provider and birth space: if you know you want a natural birth, do your homework now. Find a care provider that supports your choice. The other thing to evaluate is whether your birth space and your birth vision are aligned.  If either of these is a NO, you can change providers and/or birth spaces – no permission slip necessary.

Pain is not normal: your body can do pregnancy pain-free. Are you uncomfortable? Look into chiropractic care, acupuncture, pregnancy massage, aromatherapy...decide what you will do to eliminate any physical pain or anxiety so you can prepare for a positive birth experience.

Pamper yourself: Say YES when it comes to being kind to yourself.  Get the pedicure, go out to dinner, eat your favorite foods that are safe in pregnancy.  You won't know when you are ready, willing or able to afford those things after your Sweet Pea arrives.  Do it now while you still only have your schedule to manage.

About the things you cannot possibly know or control...

How long you will be pregnant: you were given an estimated due date…it’s a guess at best.  It is definitely NOT an expiration date.  Each day inside you is a day your Sweet Pea is growing and preparing to live earthside.  As long as you are okay, and they are okay, inside is a great place to be.  Find ways to enjoy being pregnant, even if your due date comes and goes.

How long your labor will be: if only there was a magic wand for this!  I love Dr. Bradley’s “formula” for labor…whether you have a “sprint”, a “marathon” or something in between, your energy and your rest determine how you manage the duration of your labor.  It is intense work, it is athletic work…so eat if you are hungry and definitely sleep, even in the excitement of “I think I’m in labor!” Eat something, drink something, go for a walk, take a bath or shower to relax you…and then go to bed!  I promise you that you cannot sleep through an unmedicated labor.  Your body will wake you up when it’s time to start that cycle again…until you can’t sleep anymore because you are working.  If you slept as suggested, you will have all the energy you need to have the birth you prepared for.  If you do not sleep, then you will have to dig down even deeper to see your birth through the way you want to – totally possible as well.  If you can, just trust me and sleep – it makes for a better birth!

When you surrender control: let go, give in, and let your baby come out.  At some point, we must let go of the present and give into the primal timelessness of birth.  I know! It sounds completely hippie-hoodoo right now.  Take it from me – I am Miss Priss and Miss Always-in-control…it makes for a LONG birth.  Your body can only get down to the real work of birth when we are willing to be vulnerable, to feel, to surrender all of the control to the bigness that is birth.  Let go – even though you are not in the driver’s seat, it does happen…without you.  It is the one time in your life when you can connect to all the birthers that have gone before you.  When I would finally surrender, I would feel all the energy in the Universe around me.  That energy sustained me, it pushed through the fear of no control, to the absolute bliss of working with our baby and my body to just Be.  A little secret: you can control your breath.  Focus on making it as deep as possible…then just feel.

Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

Here are Dr. Bradley’s "Keys to Labor", as per his book, Husband-Coached Childbirth.  I love these simple steps – they could almost be considered a “recipe” for labor.  

• Mom should eat the kind of food she is hungry for: a meal, a snack, or a nibble, depending on where she has progressed in labor. 

A laboring mother should eat to her appetite.  Early in labor, she may be ready for a full meal.  We have students who go out to breakfast after they know they are in labor just to pass the time away.  If she is hungry, feed her accordingly.  As labor progresses and the body starts to divert bodily functions exclusively to labor and birth, you will see her appetite wane.  Later in labor, maybe she will want a bite of something – and definitely not the full meal she was requesting before.  If labor has been on the longer side and she is refusing food, or if she is being denied food and she is still hungry, you may consider clear broths for the dual purpose of an energy boost and hydration.

• Mom needs to be drinking every hour.  Whether she wants a full glass, a few sips, or ice chips – keep her hydrated.

Dr. Bradley wrote in his book that a mother should “drink to thirst”.  We now know that thirst is a late sign of dehydration.  It is best to keep mom hydrated by offering her a glass of water every hour in the early stages of labor.  Again, as labor progresses, she may not want that full glass of water.  You can offer her a sip of water after every contraction, or maybe ice chips will be better.  Some mothers may even prefer sucking on a damp cloth.

• At a good pace to rock baby down and encourage labor to progress.

Walking is a great way to speed up labor.  It is always a great way to work yourself into exhaustion.  You need to gauge how it’s working for your particular labor.  When you walk, are the contractions getting harder, longer and stronger?  If walking is not having that effect on your labor, then maybe you should just go for a 20-30 minute walk to labor baby down into the pelvis and exert some pressure on the cervix to encourage it to dialate, and then move on to the next step.  If walking is clearly making your labor progress, go for it.  You could walk until mom needs more help with relaxation besides reassuring words and counter-pressure.

• Water has been called the “midwife’s epidural”. A warm shower or bath can do wonders to ease the intensity of labor.

Water has an incredibly relaxing effect.  It can literally wash the tension away.  Some mothers may like the full submersion and weightlessness in a birth tub.  Other mothers may prefer the soothing sound and the sensation of water flowing down her body.  If your birth place has the equipment, try both and see what works for her.  You may want to consider limiting your use of water to an hour at a time if mom is in the tub.  See THIS article from Penny Simkin for more information about how to use water in labor.

• Now that Mom has fueled, hydrated, moved baby, and eased tension, do a relaxation exercise to ease her into a rest period.  An unmedicated mother *will not* sleep through the birth of her baby.

Mom has done everything she can to ensure a healthy, low-risk labor. She has nourished and hydrated her body as it prepares for the athletic event of birth.  She has walked to move baby and help dilate the cervix.  She has used water to dissipate any tension she may have been holding onto.  Now it’s time to encourage her into a side relaxation position, or which ever other position is comfortable enough for her to enter a state of deep relaxation.  Optimally, you want the mother to get a good sleep.  If it’s nighttime, then maybe she can sleep through the night, or until her contractions wake her up again.  If it’s during the day, hopefully she can get a decent nap.

“Nil per os (alternatively nihil/non/nulla per os) (NPO) is a medical instruction meaning to withhold oral food and fluids from a patient for various reasons. It is a Latin phrase which translates as "nothing through the mouth". In the United Kingdom, it is translated as nil by mouth (NBM).

Typical reasons for NPO instructions are the prevention of aspiration pneumonia, e.g. in those who will undergo general anesthetic, or those with weak swallowing musculature, or in case of gastrointestinal bleeding, gastrointestinal blockage, or acute pancreatitis. Alcohol overdoses that result in vomiting or severe external bleeding also warrants NPO instructions for a period.

When patients are placed on NPO orders prior to surgical general anesthesia, physicians would usually add the exception that patients are allowed a very small drink of water to take with their usual medication. This is the only exception to a patient's pre-surgery NPO status. Otherwise, if a patient accidentally ingested some food or water, the surgery would usually be canceled or postponed for at least 8 hours.”

“In 1946 Dr. Curtis Mendelson hypothesized that the cause of pneumonia following general anesthesia was aspiration of the stomach contents, due to delayed gastric emptying in labor. He noted that food could be vomited 24-48 hours after being eaten. Dr. Mendelson experimented on rabbits to examine the effects of content in their lungs. Aspiration (taking the particles into your lungs) of undigested food could cause obstruction, but not aspiration pneumonia, and no deaths were due to aspiration of fluids with a neutral pH. The rabbits only died when they aspirated materials containing hydrochloric acid. He said by forbidding food and drink in labor you could reduce stomach volume, thereby decreasing the risk of maternal problems from acid aspiration while under general anesthesia. We also found that there were two factors that increased the risk of maternal problems:

• A volume of an aspirate of 25+ mm
• A pH of 2.5 higher (biggest problem)

However, in the 40's and 50's general anesthesia was used much more often for labor and delivery. For example, most forceps were done under general anesthesia. Gases were given with a face mask, often opaque, which hampered the anesthesiologist's view of the airway. Dr. Robert Parker, in 1950, largely blamed aspiration on poor anesthetic technique and poor quality of the practitioners.

“The risks of aspiration are only a problem when general anesthesia is used (3.5-13% of cesareans), and the technique has improved. Anesthesiologists now have more quality control.

So the two solutions that have been the most popular have been the IV and antacids before a cesarean surgery.

IV fluids are not always reasonable solution to hydration problems, as they have problems of their own: over load, closer monitoring of intake and output, hyperinsulinism in infants after 25 g of glucose, and the salt free solutions can result in serious hyponatraemia in mom and baby. And the antacids are usually given in the quantity of 30 mm, a volume known to increase the risks of aspiration pneumonia.

We also know that restricting food in labor can cause problems of its own. Besides the stress factors, restricting intake during labor can cause dehydration and ketosis.”

• Stress factors caused by denial of food and water
• Dehydration
• Ketosis
• Longer labor: women who are allowed to eat and drink to comfort in labor have shorter labor (by an average of 90 minutes)
• May need augmentation with Pitocin
• May require more pain medications
• In one study, babies had lower apgar scores than of those in the control group. [2]

II. Aspiration Prevention

Clear Liquids.

There is insufficient published evidence to draw conclusions about the relationship between fasting times for clear liquids and the risk of emesis/reflux or pulmonary aspiration during labor. The consultants and ASA members both agree that oral intake of clear liquids during labor improves maternal comfort and satisfaction. Although the ASA members are equivocal, the consultants agree that oral intake of clear liquids during labor does not increase maternal complications.

Recommendations.

The oral intake of modest amounts of clear liquids may be allowed for uncomplicated laboring patients. The uncomplicated patient undergoing elective cesarean delivery may have modest amounts of clear liquids up to 2 h before induction of anesthesia. Examples of clear liquids include, but are not limited to, water, fruit juices without pulp, carbonated beverages, clear tea, black coffee, and sports drinks.∥ The volume of liquid ingested is less important than the presence of particulate matter in the liquid ingested. However, patients with additional risk factors for aspiration (e.g., morbid obesity, diabetes, difficult airway) or patients at increased risk for operative delivery (e.g., nonreassuring fetal heart rate pattern) may have further restrictions of oral intake, determined on a case-by-case basis.

In some cultures, food and drinks are consumed during labour for nourishment and comfort to help meet the demands of labour. However, in many birth settings, oral intake is restricted in response to work by Mendelson in the 1940s. Mendelson reported that during general anaesthesia, there was an increased risk of the stomach contents entering the lungs. The acid nature of the stomach liquid and the presence of food particles were particularly dangerous, and potentially could lead to severe lung disease or death. Since the 1940s, obstetrical anaesthesia has changed considerably, with better general anaesthetic techniques and a greater use of regional anaesthesia. These advances, and the reports by women that they found the restrictions unpleasant, have led to research looking at these restrictions. In addition, poor nutritional balance may be associated with longer and more painful labours, and fasting does not guarantee an empty stomach or less acidity. This review looked at any restriction of fluids and food in labour compared with women able to eat and drink. The review identified five studies involving 3130 women. Most studies had looked at specific foods being recommended, though one study let women choose what they wished to eat and drink. The review identified no benefits or harms of restricting foods and fluids during labour in women at low risk of needing anaesthesia. There were no studies identified on women at increased risk of needing anaesthesia. None of the studies looked at women's views of restricting fluids and foods during labour. Thus, given these findings, women should be free to eat and drink in labour, or not, as they wish.

"There should be no hospital policies which restrict fluids and foods in labor; nor should formal guidelines tell women to take specific foods, such as energy drinks," states one of the study's authors, Gillian ML Gyte, M.Phil, of the department of women and children's health at the University of Liverpool in the U.K.

She and her co-authors point out that prior research has shown that many women in labor do not feel like eating, but for others the notion of long hours without any food or drink can be anxiety provoking.” …

"Our study found no difference in the outcomes measured, in terms of the babies' wellbeing or the likelihood of a woman needing a C-section," said Gyte. "There is no evidence of any benefit to restricting what women eat and drink in labor." The researchers also emphasize the value of allowing women to make choices regarding these matters. 

Throughout much of the last century, eating and drinking during labour was considered dangerous and many maternity units operated "nil by mouth" policies or restricted what women in labour were allowed to eat and drink, regardless of women's preferences. This was largely due to concerns about possibly fatal damage to the lungs caused by "Mendelson's syndrome," where particles of regurgitated food are inhaled under general anaesthetic during Caesarean sections. Recently, however, attitudes have begun to change and in many maternity wards, particularly in the UK, women are now allowed to eat and drink what they want during labour…

"Since the evidence shows no benefits or harms, there is no justification for nil by mouth policies during labour, provided women are at low risk of complications," said lead researcher Mandisa Singata, who is based at the East London Hospital Complex in East London, South Africa. "Women should be able to make their own decisions about whether they want to eat or drink during labour, or not."…

"While it is important to try to prevent Mendelson's syndrome, it is very rare and not the best way to assess whether eating and drinking during labour is beneficial for the majority of patients. It might be better to look at ways of preventing regurgitation during anaesthesia for those patients who do require it," she said. 

So what is a couple to do when the hospital has a policy that restricts food and drink during labor?  Do you feel confident in your choice to eat and drink?  Do you want to circumvent the system by bringing in “Coach’s Food”?

That is a very individual choice.  You can labor at home as long as possible and follow your own cues if you want to prolong going to the hospital where your intake is going to be restricted.  You can pack some “Coach’s Food” and circumvent the system by snacking out of the coach’s cooler.  You can do neither and go with the system.  You can also talk to your care provider, bring in the scientific literature, and see if they will sign off on a birth plan that allows you to eat and drink in the hospital in spite of the policy.  Their hands may be tied, and it may not be a possibility, however as the saying goes, you won’t know unless you try.

Did your birth place have a policy that restricted food and drink?  What did you do; how did you handle it?
Please leave us a comment – it will be moderated and posted.

[1] Singata M, Tranmer J, Gyte GML. Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD003930. DOI: 10.1002/14651858.CD003930.pub3.

[2] Health Behavior News Service, part of the Center for Advancing Health (2013, August 22). Restricting food and fluids during labor is unwarranted, study suggests. ScienceDaily. Retrieved September 10, 2013, from http://www.sciencedaily.com/releases/2013/08/130822141954.htm

[3] Wiley-Blackwell (2010, January 22). Eating and drinking during labor: Let women decide, review suggests. ScienceDaily. Retrieved September 10, 2013, from http://www.sciencedaily.com/releases/2010/01/100119213043.htm

Disclaimer:  
The material included on this site is for informational purposes only.  It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

The night arrived again – when we say farewell to our students and wish them the best for their birth and the journey of family upon which they are about to embark.  Bruss always tells the first-time parents that he is jealous of them because there is nothing else like the experience of welcoming your first child and discovering parenthood for the first time.

• They have learned several strategies for positive communication. 
• There are several places in their class materials to find the questions for informed consent.  If they remember nothing else, the first questions to ask are, “Is Mom okay?  Is Baby okay?  Then they can ask for the benefits, risks, expected results, alternatives to the suggested procedure, and a timeframe to think about it before making a decision.
• If there is time, it is always okay to ask for the privacy to talk things through before making a decision.
• Always evaluate any decisions that need to be made with the Healthy Mom, Healthy Baby filter on.  As long as they remember the ultimate goal, they will be able to make peace with the decisions they make in labor.

• The amount of sleep a couple gets can positively or negatively effect their outcome.  Against the odds, try to sleep in spite of the excitement.
• Eat if you are hungry, drink if you are thirsty.
• Fast labors are indicated by a rapid progression of duration, intensity and frequency of the contractions.  If you notice that things are getting longer, harder, stronger and closer together over the course of a couple of hours, you need to get to your birthplace sooner than later.
• Long labors are indicated by little or no change in the duration, intensity and frequency of contractions over the course of several hours.  If your contractions start ten+ minutes apart, and they are still ten+ minutes apart two hours later,  you are in for a marathon – stop timing, eat something, hydrate, shower and go to bed!  Although we do not wish this labor on anyone, if it is your birth story, you will be happy you rested early on, because you will definitely have energy when you need it later.
• It is possible to sleep between contractions or even through contractions.  Surrender to the process and allow Mom to rest.
• Relaxation is on physical, mental and emotional levels.  There are several summary pages we cover so that they can find and refer to what they need at different points in their labor.

• They are about to embark on one of life’s greatest gifts.
• It’s called “mother’s instinct” for a reason – it is unexplainable and a mystery how we are all connected, however, if they have any feelings or sense anything as it applies to their baby or their family, go with it – they are invariably proven to be the right decisions to make.
• They are not alone – reach out for help if they are feeling overwhelmed, tired or just need another adult to talk to when Coach goes back to work and they are home alone with baby.
• Nursing should not hurt, and it is also a learned behavior.  Each breastfeeding relationship is unique with subsequent children.  If they experience any pain, difficulty, or as questions arise, there are several free options from which to find answers: La Leche League, hospital support groups, community support groups.  If they experience any fever or lingering pain, get professional help from a medical care provider: it is best to be told how to find a solution early on, than to let things go and get into a situation where the breastfeeding relationship is compromised.
• They cannot spoil or hold their baby too much.  It is okay to ignore people who tell you otherwise!  Your baby is designed to be with you and a part of you – they are cute, sweet and cuddly for a reason!  The time in our lives when they need us is so short compared to the time they are independent, so savor every moment of their infancy and hold them as much as you want to!
• The sound of your child's crying makes your heart hurt for a reason – you are supposed to respond to them and meet their needs.  If the basics of wet, hungry and tired are satisfied and they are still crying, there may be other reasons why they cry: lonely, scared, in pain, over-stimulated…all of them good reasons to hold them and reassure them that it is okay and you will find a path together.

• Mom and Baby will continue to be an exclusive unit for a little while longer.  Until Coaches are allowed into the “Inner Circle”, there are many ways to support that MotherBaby unit so that they thrive and succeed: support the mother’s decision to breastfeed by bringing her food and water every time she nurses, hold the baby so she can sleep and build her milk supply and stay rested to avoid postpartum issues, change the baby’s diaper so mom can take care of her personal needs, keep telling her that she is doing a great job and you appreciate everything she is doing to take care of your child.
• Even if you feel you are outside of the circle, there are special things that only Coaches can do.  You can soothe the baby when mom needs a break.  Coaches have a different energy that babies respond do.  One mom shared a tip they learned in breastfeeding class:  Moms always smell like milk.  If there is fussiness at the breast, Dad can take baby and calm him/her since he doesn’t stimulate their sense of smell for food…and when everyone is in a better place, they can try nursing again.
• The time will come when you become part of that “Inner Circle”.  Your baby will recognize you and crave your attention – enjoy it!  You can sing to them, read to them, snuggle with them even before you feel completely “in”, and by the time you are “in”, baby will be confident and comfortable with you; the rewards of taking a vested interest in your child are immeasurable.