Stages of Labor

The first stage of labor is the longest and involves three phases, early, active and transition. Early labor is the onset of labor until the cervix is dilated to 3 cm. Active labor continues from 3 cm until the cervix is dilated to 7 cm and transition continues from 7 cm until the cervix is fully dilated at 10 cm.

The second stage is often divided into a passive phase, an active phase, and the actual birth of the baby. The passive waiting phase of the second stage of labor is a period of rest, sometimes called “laboring down” when the baby rotates and descends toward the pelvic floor. The passive phase happens when the mother is fully dilated but waiting for the urge to push. It is important to wait for the active phase before starting to push or pushing can cause an anterior lip to develop.

The active pushing phase is when the baby’s head is on the pelvic floor and the mother pushes spontaneously. Essentially the mother cannot not push. A lot of mothers prefer active pushing over dilation because they feel like actively involved and they can feel their baby descend. It can take a lot of effort. Pushing can last two or three hours. If can be helpful to put chin to chest, curl around the abdomen, and grab legs behind the knees. Ultimately listen, your body knows what to do!

Once burning or the ring of fire is felt, avoid pushing and instead use horse lips and let the tissues expand. Waiting this short time protects the perineum and can prevent tearing. Sometimes extremely high levels of adrenaline can trigger the fetal ejection reflex. This surge triggers strong, rapid contractions which move the baby from the uterus and into the birth canal. The baby is born quickly and easily without voluntary pushing from the mother.

The third stage is the delivery of the placenta and is the shortest stage lasting about 20 minutes. Mothers wait until they feel some cramping, then push out the placenta. Having the baby play at the breast or squatting can help.


Movement in Labor

This blog post focuses on explaining the benefits of different birthing positions in labor. Labor is like a dance between you and your baby. Movement helps bring the baby down and through the pelvis.

First, let’s review the stages of labor. The first stage of labor is the longest and involves three phases: Early labor is the time of the onset of labor until the cervix is dilated to 3 cm. Active labor continues from 3 cm until the cervix is dilated to 7 cm and transition continues from 7 cm until the cervix is fully dilated to 10 cm. The second stage or pushing lasts until your baby is born. The third stage is the delivery of the placenta and is the shortest stage.

It is important to rest during early labor. As hard as it is napping is critical. Laboring people who do not rest, often deal with exhaustion during second stage or pushing.

In active labor, a rotation of movement, hydration, and urination is helpful, in addition to resting as needed. It is also beneficial to change positions every two or three contractions until you find what works best. That works best is generally what is the most intense.

For first-time moms’ upright positions are useful during second stage or pushing. Giving birth in an upright position can be physiologically beneficial to the mother and baby. In upright positions, gravity helps bring the baby down and out. Upright positioning also enables the uterus to effectively contract strongly and efficiently and supports the baby best position to pass through the pelvis. Research indicates that squatting, kneeling or hand and knees positions increase the dimensions of the pelvic outlet. Moms who had babies before or moms’ who birth fast may not need the upright positions. Sometimes these birthing people push side-lying position with a raised leg.

Most of the time the placenta is born within 20 minutes. Sometimes a supported squat is useful when delivering the placenta.

While it is good for pregnant women to review laboring positions prior to labor. It may be beneficial to google different labor positions. Midwives are experts in knowing the best positions for different stages of labor. I cannot stress the importance of listening to your own body. All mammals know how to birth their babies, so do you! Listen to your body.




The Importance of Skin to Skin after Birth

There is significant evidence that newborns who receive skin to skin contact with their mothers immediately after birth have an easier transition. Skin to skin often called kangaroo care is when babies are held naked against their mother’s skin for a minimum of 1 to 2 hours after birth. Midwives would argue skin to skin contact is beneficial several hours a day for a least 2 weeks. There are many reasons to implement kangaroo care. Babies have great respiratory, temperature and glucose stability in addition to decreased stress. Skin to skin transfers biomes from mother to baby. These biomes protect the baby for life. After the umbilical cord has stopped pulsating and been cut, Dads can provide skin to skin contact until the mother is ready to breastfeed. Once breastfeeding babies lay naked or diapered between the mother’s breast. Initially, babies may play with the breast until ready to latch. Ideally, newborns breastfeed within the first hour after birth. Breast milk is made by your body specifically for your baby. Along with nutrition, breastmilk contains antibodies that protect your baby from illness. Babies tend to cry less, leading to less parental stress and anxiety. When the baby passes through the birth canal, the baby’s gut is colonized with bacteria from the mother’s vaginal. Skin to skin continues to expose the baby to the mother’s bacteria and microbes. This early exposure helps babies develop their own healthy bacteria. Exposure to microbes is associated with protection of inflammatory bowel disease and asthma. While mothers benefit from this practice by keeping the uterus firm which can decrease bleeding. Skin to skin also increases breastfeeding success and decreases postpartum depression. Studies suggest that benefits for babies can persist for years. Skin to skin improves maternal attachment behavior, reduced maternal anxiety, enhances child cognitive development and increases successful breastfeeding. Once this time is over you can’t get it back, so stay in bed, snuggle up and love your babe. Diapers are okay, and a blanket can be used for warmth.


For centuries giving birth at home was the norm. In the early 1900’s women started going to the hospital to give birth. Eventually, home birth declined from 50% in 1938 to fewer than 1% in 1955, with the interventions and the perceived ease of birth, women felt safer in hospitals.

A conflict between surgeons and midwives arose, as doctors began to assert that their modern scientific techniques were better for mothers and infants than midwifery. As doctors and medical associations pushed for a legal monopoly on obstetrical care, midwifery became outlawed or heavily regulated throughout the United States and Canada. An organized campaign accused midwives of being “incompetent and ignorant.”

Today midwives are recognized as highly trained, specialized birth professionals in “normal” birth. There are two kinds of midwives Certified Professional Midwives (CPM) and Certified Nurse Midwives (CNM). CPM’s attend home births while most CNM’s work in hospitals, some also attend homebirths.

Homebirth Midwifery care is based on the idea the pregnancy and birth are normal physiological process and provides prenatal care with individualized education, counseling, and continuous hands-on assistance during labor and delivery, in addition to, postpartum support while monitoring psychological and social wellbeing.

This type of care is contrast to the medical model that often promotes pregnancy and childbirth as potentially pathological and dangerous.

The midwifery model plays a significant role in Sweden and the Netherlands. In Sweden midwives administer 80 percent of prenatal care and more than 80 percent of family planning services. Swedish midwives attend all normal births in public hospitals and Swedish women have fewer interventions in hospitals than American women. The Dutch infant mortality rate in 1992 was the tenth-lowest rate in the world, at 6.3 deaths per thousand births, while the United States ranked twenty-second. Midwives in the Netherlands and Sweden owe a great deal of their success to supportive government policies.

In the USA, 27 states license or regulate direct-entry midwives, or certified professional midwife (CPM). In the other 23 states there are no licensing laws and practicing midwives can be arrested for practicing medicine without a license. Some of these states are in process of legalization. It is legal in all 50 states to hire a certified nurse midwife, or CNM, who are trained nurses, though most CNMs work in hospitals. Please see the chart listed below for further information.

Vaginal Birth After Cesarean: the Facts

Women who choose a VBAC have special needs and concerns that are social, psychological and clinical. A skilled Certified Professional Midwife uses all her talents- intellect, interpersonal communication, intuition and judgment to inform, nurture, protect and empower the women in her care.

The Center for Disease Control and Prevention (CDC) reports that the US cesarean rate slightly declined from 32.7 to 32.2% in 2014.  Many women are now attempting vaginal birth after cesarean (VBAC) for their subsequent births.  In 2014, reported in that Wisconsin’s VBAC rate was 26.1%.  Many Certified Professional Midwives (CPM) support VBAC’s as an option for women who have had previous cesarean deliveries.  In Wisconsin, CPM’s can attend home birth vaginal birth after cesarean (HVBAC) after consulting with a CNM or physician regarding the individual VBAC client. The American Pregnancy Association suggests 90% of women who have undergone cesarean deliveries are candidates for VBAC.  VBAC can be extremely therapeutic for women who have felt disappointed and/or angry about a prior birth experience.

First, why is the cesarean section rate so high? The most common obstetric procedure electronic fetal monitoring (EFM) has benefits and risks.  Some suggest EFM is used to monitor the baby’s heart rate during labor so interventions can occur if the baby is in distress.  EFM is also used so nurses can monitor multiple labors at the same time. Studies suggest EFM can lead to an increase in cesarean sections.  It has been shown that women with continuous EFM were 1.7 times more likely to have a cesarean and likely to require pain medication when compared to women with intermittent auscultation during labor.

Often in the hospital women are told that as VBACs they can have a trial of labor (TOL) which implies that their body is not ultimately capable of a vaginal birth.  With careful risk assessment, there is no reason to suggest that most women will not be successful.

Women who have had a low-transverse uterine incision have the highest rate of successful VBAC.  As reported in Outcomes of Care regarding 16,924 Planned Home Births in the United States:  the Midwives Alliance of North America Statistics from, 2004 to 2009, report that 1100 women attempted a VBAC with a success rate of 87%.  Why the high success rate?  It’s simple, homebirth allows women to birth without interfering with the physiological process.  The 87% success rate suggests that the idea once a c section, always a c section is not the case.  This outdated philosophy is changing around the country.

There are three main obstetrical complications that can sometimes occur with scarred uteruses. The first is placenta previa, which is when the placenta covers the opening of the cervix.  The second obstetric pathology is placenta accreta and percreta. These are abnormally implanted placentas, which invade the uterine wall. Placenta accreta and percreta is why it is important to verify the position of the placenta in second trimester with ultrasounds.  The third antepartum complication is uterine rupture which can happen during any birth, even when no scar tissue is present, and results predominantly if Pitocin is used.  Placenta previa, placenta accreta/precreta and uterine rupture require a cesarean section.

There are several contraindications to VBACs.  These circumstances include: classical (vertical) scar on the uterus, T- or J-incision on the uterus, previous surgery such as myomectomy, which remove fibroids from the uterus, a truly contracted or deformed pelvis, or obstetrical complications, such as, placenta previa that preclude vaginal delivery.

CPM’s undertaking home VBAC need to learn the physical and psychological differences of VBACs.  For instance, VBACs can have longer births.  Midwives who accept VBAC’s need to have a VBAC practice protocol, engage in informed consent, request an ultrasound in the third trimester to determine the placement ensure it is not overlapping the scar.  Lastly and as always, these CPMs need to have an emergency care plan completed in the event of transfer. VBAC protocols vary among midwives. An important factor is the reaction of the EMS, as well as the responsiveness of a back-up doctor and hospital to a midwife’s emergency call. Essentially a rural midwife working with a small hospital will have a different protocol than to urban midwife who is minutes from a trauma center.  For more information, contact Raquel at

The Difference between Midwives and Doulas

Midwives and doulas both attend births, so they are the same, right? Well, actually, no, they are not. The roles of each profession are quite different. Some women wonder if they need one or the other; often, they choose to have a midwife or sometimes both.

Midwifes are skilled healthcare professionals who are experts in normal birth. Midwives use the Midwives Model of Care which supports that fact that pregnancy and birth are normal biological and physiological life processes. Midwives offer specific individualized care based on the needs of woman and babies. They provide medical advice and encourage informed consent. Midwives conduct prenatal appointments, obtain prenatal labs, administer hemorrhagic medications and suture tears if needed. Midwives statistically have significantly lower rates of interventions.

Midwives can either be a certified nurse midwife (CNM) or a certified professional midwife (CPM). Nurse midwives often work in hospitals, while certified professional midwives offer care and support in birth centers or provide homebirth services in the comfort of people’s homes. If the care required is outside the scope of midwifery, the women (and/or baby) is referred to another healthcare provider.

There are two types of doulas: birth and postpartum. Birth doulas offer advice, information, plus continuous emotional support and physical comfort, mainly to a mother, but also the father before, during and after childbirth. Birth doulas often facilitate communication between laboring moms, partners, and health care providers. A postpartum doula provides support and education on breastfeeding, recovery from birth, mother/baby bonding, infant soothing and newborn care. A postpartum doula supports families in those first days and weeks after their baby is born. Neither type of  doula  provides medical treatments.

Doulas are trained at a weekend course. They can be certified through DONA International or uncertified. Doulas attend births in homes, birth centers and hospitals. Postpartum doulas support families in the comfort of their homes.

Midwives and doulas support pregnant, laboring and postpartum woman in different ways. Basically, a midwife is a healthcare provider, while a doula is more like a childbirth coach.   For more information, contact Raquel at



Delayed Cord Clamping

There are several ways to  define delayed cord clamping.  According to the World Health Organization (WHO), delayed cord clamping is cutting the cord 1-3 minutes after birth, a practice the WHO recommends for all births.  Home birth midwives practice delayed cord clamping where the umbilical cord is not clamped and cut until the cord has stopped pulsing or until after the placenta is delivered.  Delayed cord clamping is known to improve maternal and infant outcomes.

Before birth, the fetus and placenta share a blood supply separate from the mother’s. The placenta and umbilical cord provides the baby with oxygen, nutrients plus clears waste. During fetal life, the placenta performs the role of lungs, kidneys, gut and liver for the fetus. This is why a significant portion of the baby’s total blood volume is in the placenta at any given time. The blood circulating in the placenta is not ‘extra’ blood or waste it belongs to the baby.

Immediately after birth, the placenta continues to provide essential oxygen and nutrients, as the placenta pulsates, placenta transfusion, a vital part of the birth process, transfers blood back to the baby. Placental transfusion provides red blood cells, plus stem and immune cells, in addition to, blood volume. Delayed cord clamping allows time for the placental transfusion, ensuring adequate oxygen levels and blood volume in the baby.

The benefits of delayed cord clamping for the baby include a healthy blood volume for the transition to life outside the womb, plus a full count of red blood cells, stem cells and immune cells. Newborns with delayed cord clamping have higher hemoglobin levels 24 to 48 post partum and less likely to be iron deficient three to six months after birth.  For the mother, delayed clamping can prevent complications with delivering the placenta and prevent postpartum hemorrhage.  Contact Raquel at

Water Births

Water Births

After a long hard day, people often like to take a long, warm bath.  So for a lot of pregnant woman, a water birth is enticing.

A water birth is the process of giving birth in a tub of warm water.  Water births can alleviate pain and promote a gentle transition for the baby.  Some women begin labor in the water, but decide to get out for the birth.  It all depends on the desires of the laboring woman.

There are many benefits of a water birth for the mother.  First, warm water is relaxing, comforting and soothing.  It allows women to focus on the birthing process.  In active labor and transition, water has shown to increase a woman’s energy, and the buoyancy allows free movement and makes frequent position changes easier.  Women tend to have improved circulation, resulting in better oxygenation which causes less pain for the mother and additional oxygen for the baby.  Water seems to reduce stress- related hormones and allows the production of endorphins which serve as pain inhibitors.  Immersion in water can also lower blood pressure.  Lastly, but equally important, water reduces perineal tears.

There are two benefits for the baby. A water birth provides an environment similar to the amniotic sac and it eases the stress of birth.  Babies seem to enjoy the water as much as mothers do.  People often think babies are in danger of starting to breathe underwater, but remember, babies perform under water just as well as in amniotic fluid.

There are several instances when a water birth is not a good idea; if the mother has a herpes outbreak, if the baby is preterm or if a thick meconium is seen in the amniotic fluid after the waters have broken.  However, in general, water births can be a comforting and beneficial aid to labor and birth.  For more information, contact me at