Up your sleeve or in your bag of tricks?

The most important thing I can say is to assess your patient's needs. Everyone deals with labor differently. For some a soft whispers of encouragement work well, others need conversation, still others need silence. Some want free movement others Jacuzzi and some want to sit or lay. I always try to figure out what is best for the individual.

I usually ask them questions when we first meet.

What classes did you take what books did you read? - I've read most of the popular natural childbirth books. By asking this question I know what they specifically want and what approach they are taking. This also allows me to speak in their language; most techniques have their own special lingo.

Why did you choose natural childbirth? -I find this important because it allows you to help them reach whatever goal they have. (Be careful how you offer this question, if you're not careful some may think you are trying to sway them toward medication)

What can I do to help you? -People will often give you good information here.

I also always go over birth plans with them. I explain what we normally do and offer explanations. It's important to always make it clear that suggestions you make are just that "only you have the right to say what is done to your body and baby". I've only once encountered strong resistance to the basic things we need to do. Always offer explanation of procedures most patients are open to interventions if they understand the reason behind them. Also you must evaluate the necessity of the procedure. Things like a gown are standard but really can be optional. Monitoring can be reduced to the minimum your written policy requires. One thing I do (some people may strongly disagree with this) even if they say not to offer pain meds, I explain that I will offer them if things become bad. I've never really done this but had an experience where I should have and I won't let that happen again. Also it's important that you let them know that the patient makes the decision and that no matter how caring the partner is you will not honor choices they make for the patient.

If the patient has a doula then assess her techniques and abilities. There are some very good dulas and some very bad ones. If your doula is doing her job then you need only interject occasional encouragement and agreement with the doula.

If the doula is not doing her job then you need to take over, sometimes this is easy and can be done by simply making suggestions on positions and staying in the room to encourage the patient. Other times you'll need to gently ask a doula to cooperate and still other times it has to be less then gentle.

The basics are:

1. Show your patient that you are there to support her and that you both respect and will support her choices.

2. Don't allow yourself to fall into habits, observe your patient and make suggestions that are specific to her personality and beliefs.

3. If a patient is doing something weird but it isn't dangerous and seems to help her, let her do it.

4. Even more then pain, exhaustion is natural childbirth's enemy. Find ways to conserve your patient's energy i.e. warm bath, massage, and fluids, quite instead of loud vocalization.

5. Movement progresses labor and relives pain as well as diverting attention from pain

6. Encouragement is very important at the same time don't patronize.

7. At some point most patient will say "I can't do this!" don't whip out the pain meds immediately. Assess your patient- how close is she to delivery? How much energy does she have left? Will continuing without pain meds be more traumatizing then achieving her original goal? In the end you have to do what the patient asks but you can sway them toward one or the other if you provide reason for it.

8. You are there to support her. You must set aside your own feelings even in regards to her. I guess what I'm trying to say is empathize don't sympathize. If your patient senses that you are sad for her it might weaken her resolve. It's okay to show you care and realize she is in pain just don't act like it's the worst thing you have ever seen.

9. Just be present, a woman in labor needs to feel that people are taking care of her so she doesn't need to spend energy worrying about those things. Also they just need that connection of another human being. If her spouse, family or doula are doing this make sure you don't compete with them but if they aren't, step in and be that support person.

10. Some patients just scream, if that's the case then just let them do it. Most likely they will delivery quickly or tire out and stop. Sure you can calm them down and if labor is going slowly you really need too. However if they are progressing rapidly just let them scream and at the time of crowning get in their face make eye contact and make them focus on you while you tell them what to do. Be caring but firm and give them instructions so they don't jump off the table, hit people, close their legs or blow out their bottom.

Good books are:

Birth without fear (best book I ever read, can be hard to find)

The labor progress handbook

Birthing from within

Hypnobirthing

Husband-Coached Childbirth: The Bradley Method of Natural Childbirth (I really don't like this method but its widely used so it's important to know what it's about)

Preparation for Birth: The Complete Guide to the Lamaze Method

Also google CAPPA and DONA - their websites have some good stuff and links to other good stuff

I'm sure I left out lots of stuff but I already wrote a small book. Lemme knw if you ahve any questions.

Dayray's post is excellent.

I also recommend this book by Penny Simkin:

The Labor Progress Handbook

EXCELLENT resource.

I also own Varney's Midwifery. Lots of good information in there.

GOOD LUCK.