Labor, Birth, Induction, Medications & Loss
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Night 2 curriculum overview
Tonight we move from pregnancy to the labor room. Read through the stages of labor, the hormonal symphony, induction, pain relief options, and what to do when birth gets complicated.
Online Night 2 · 5:30 PM to 8:00 PM CST · Microsoft Teams
Labor, Birth, & When
Things Get Complex
Tonight you learn what labor actually looks like, hour by hour, hormone by hormone. You learn how to support a person through unmedicated labor, an epidural, an induction, a cesarean — and through the kind of loss that no one prepares you for.
By the End of Tonight, You Will Be Able To
- Describe the four stages of labor and the phases within each stage
- Explain the hormonal symphony of labor and how the environment supports or disrupts it
- Identify the Six P's that influence the course of labor
- Describe common induction and augmentation methods and the doula's supportive role
- Compare pain-relief options — non-pharmacologic, nitrous, IV meds, epidural, spinal — and use the BRAIN framework with clients
- Recognize complications including OP position, prolonged labor, shoulder dystocia, and unplanned cesarean
- Hold space with families through perinatal loss with cultural humility and clinical awareness
Tonight at a Glance
| 5:30 PM | Welcome & Recap of Night 1 | 10 min |
| 5:40 PM | Stages & Phases of Labor | 35 min |
| 6:15 PM | The Hormonal Symphony & the Six P's | 25 min |
| 6:40 PM | Break | 15 min |
| 6:55 PM | Induction, Augmentation & Pain Relief Options | 40 min |
| 7:35 PM | When Birth Needs Help: Complications & Cesarean | 15 min |
| 7:50 PM | Perinatal Loss & Holding Space | 15 min |
| 8:05 PM | Key Takeaways & Closing | 10 min |
Section 1 — Stages & Phases of Labor
Labor is not one long stretch. It is four distinct stages with predictable physical and emotional landmarks. Knowing where a person is helps you know how to support them.
Stage 1, Early/Latent — 0 to 6 cm
What's happening: Cervix is softening, thinning, and slowly dilating. Contractions are mild to moderate, irregular, typically 5–20 minutes apart.
Doula focus: Rest, hydrate, normal-life distractions. Bath, walk, snack, sleep if it's nighttime. Do NOT exhaust her here.
Length: Hours to days. Highly variable.
Prodromal Labor — "False" labor that's real
Contractions that start and stop over days, with little to no cervical change. Emotionally exhausting. Validate the experience — this IS labor doing prep work, not "nothing."
Doula focus: Sleep, calories, reassurance. Position changes (Spinning Babies). Remind her: every contraction is doing something.
Stage 1, Active — 6 to 8 cm
What's happening: Contractions stronger, longer, closer — usually 3–5 minutes apart, 45–60 seconds long. Talking through contractions becomes hard. She's IN it now.
Doula focus: Continuous physical support. Hip squeezes, counter-pressure, hands-and-knees, shower, tub. Slow breath. Quiet voice. Low lighting.
Hospital tip: This is typically when admission happens (5-1-1 rule, or 4-1-1 for second-time parents).
Stage 1, Transition — 8 to 10 cm
What's happening: The shortest, most intense phase. Contractions every 2–3 minutes, 60–90 seconds. Shaking, nausea, "I can't do this," self-doubt — these are SIGNS, not problems.
Doula focus: "You ARE doing it. You're almost there." Stay close. One contraction at a time. Don't introduce new ideas now.
Stage 2 — Pushing & Birth
What's happening: Complete dilation through baby's birth. Can last minutes to several hours. "Rest and be thankful" pause is normal — contractions sometimes space out before the urge to push kicks in.
Doula focus: Encourage upright, gravity-friendly positions if possible. Mother-led pushing over directed pushing whenever the care team allows it. Cool cloths. Affirmations. Mirror — offer, never push.
Stage 3 — Birth of the Placenta
What's happening: 5–30 minutes after baby is born. Mild contractions, gentle pushes, placenta delivered. Active management (Pitocin) is now standard in U.S. hospitals to reduce hemorrhage risk.
Doula focus: Skin-to-skin with baby, support breastfeeding within the first hour, watch for the "magical hour" hormone surge.
Stage 4 — The Golden Hour
What's happening: The first 1–2 hours postpartum. Oxytocin and prolactin peak. Bonding window. Body begins involution. Vitals monitored closely.
Doula focus: Protect the bubble. Dim lights, fewer voices, skin-to-skin, latch within the first hour if breastfeeding. Hold space — let her process out loud.
Section 2 — The Hormonal Symphony
Labor runs on hormones, not willpower. Your job is to protect the environment so the body can do what it already knows how to do.
| Hormone | Role & Doula Implications |
|---|---|
| Oxytocin | Drives contractions, bonding, milk let-down. Released best when she feels SAFE and PRIVATE. Bright lights, strangers, questions all suppress it. Keep the room dim and quiet. |
| Endorphins | Body's own opioids. Rise gradually through labor. Suppressed by interventions and stress. This is why an unmedicated transition feels distant and dreamlike when it's working. |
| Adrenaline | Fight-or-flight hormone. Stalls labor in stage 1 (the body refuses to deliver when it feels threatened). Surges helpfully in stage 2 to give her the energy to push. |
| Prolactin | The "mothering" hormone. Drives milk production and the deep instinct to nest with baby. Peaks during skin-to-skin and early breastfeeding. |
Section 3 — The Six P's of Labor
When labor stalls or struggles, providers troubleshoot through these six factors. Knowing them helps you ask better questions in the room.
- Powers — strength, frequency, and effectiveness of contractions
- Passenger — baby's size, position, presentation, and number
- Passage — shape and capacity of the pelvis and soft tissues
- Psyche — emotional state, fear, trauma history, environment
- Position — how she's holding her body; mobility supports labor
- Provider — trust, communication, and continuity of care
Section 4 — Induction & Augmentation
Induction means starting labor before it has begun on its own. Augmentation means speeding up labor that has already started. Both are increasingly common in U.S. hospital settings.
| Method | How it works |
|---|---|
| Cervical ripening (Cervidil, Cytotec) | Prostaglandin gel or pill softens the cervix to prepare for labor |
| Foley balloon / Cook catheter | Mechanical dilation of the cervix using a saline-filled balloon |
| Membrane sweep / stripping | Provider separates the membranes from the cervix to release prostaglandins |
| AROM (artificial rupture of membranes) | Manually breaking the water with an amnihook to intensify contractions |
| Pitocin (synthetic oxytocin) | IV drip that creates strong, regular contractions; titrated up over time |
The ARRIVE Trial — what doulas should know
Published in 2018, the ARRIVE trial influenced many U.S. providers to offer elective induction at 39 weeks for low-risk first-time parents. The study showed a small reduction in cesarean rates for participants, but the population studied was narrow (low-risk, first baby, willing to be randomized).
Doula role: Make sure your client knows induction at 39 weeks is an OFFER, not a requirement. Help her ask: What's my Bishop score? What's the failure rate if my body isn't ready? What happens if I wait?
BRAIN — The Decision Framework
Teach this to your clients in pregnancy so they have it ready when a decision lands at 3 AM in the labor room:
- B — Benefits. What are the benefits of this option?
- R — Risks. What are the risks?
- A — Alternatives. What else could we try?
- I — Intuition. What does my gut say?
- N — Nothing / Not Now. What if we wait an hour, or don't do this at all?
Section 5 — Pain Relief Options
There is no medal for going unmedicated and no shame in choosing relief. Your job is to support the choice she makes — and to keep supporting her after.
| Option | What it does & trade-offs |
|---|---|
| Non-pharmacologic (comfort measures) | Movement, hydrotherapy, counter-pressure, breath, heat/cold, position changes. No side effects to baby. Requires continuous support — your bread and butter. |
| Nitrous oxide (laughing gas) | Inhaled, self-administered between contractions. Takes the edge off without numbing. No effect on labor progress. Can cause nausea or lightheadedness. |
| IV narcotics (Stadol, fentanyl, nubain) | Short-acting. Take the edge off but cross the placenta. Best used in early labor — not within an hour of pushing because of newborn respiratory depression risk. |
| Epidural | Continuous regional anesthetic via catheter in the lower back. Numbs from waist down. Excellent pain relief; trade-offs include limited mobility, possible BP drop, longer pushing stage, and increased need for assisted delivery. |
| Spinal / CSE (combined spinal-epidural) | Single dose spinal for fast relief, paired with an epidural catheter. Often used in late labor or for planned cesareans. Faster onset than a standard epidural. |
The Peanut Ball: your best friend after an epidural
Place between the knees while side-lying to open the pelvis when she can't move freely. Switch sides every 30–60 minutes. Evidence shows it shortens labor and reduces cesarean rates in epiduralized parents. Ask the nurse for one — most U.S. hospitals stock them.
Section 6 — When Birth Needs Help
Not every labor follows the textbook. These are the complications you're most likely to encounter.
OP (Occiput Posterior) Position — "Back labor"
Baby is head-down but facing the wrong way (sunny-side up). Intense, unrelenting back pain between contractions. Longer labor.
Doula tools: Hands-and-knees, open-knee chest, abdominal lifting, Spinning Babies sidelying release, rebozo sifting, counter-pressure on the sacrum.
Prolonged Labor / Failure to Progress
Friedman's curve is outdated — the modern standard (Zhang) allows much longer normal labors, especially in first-time parents. "Stalled" doesn't always mean intervention.
Doula tools: Position changes every 30–45 minutes. Rest if she's exhausted. Empty the bladder. Move from bed to ball to toilet to walking. Address fear and tension — psyche is one of the six P's.
Shoulder Dystocia
Baby's head delivers but the shoulder gets stuck behind the pubic bone. An emergency. The room will suddenly fill with people and the team will move fast.
Doula role: Step back. Stay calm and present. The team may call for McRoberts position or suprapubic pressure — help if asked, otherwise let them work. Debrief and reassure afterward.
Cesarean Birth
About 1 in 3 U.S. births. Planned, unplanned, or emergency. Major abdominal surgery with a longer recovery.
Doula role: Advocate for family-centered cesarean when possible — clear drape, immediate skin-to-skin, delayed cord clamping, partner in the OR, narrating the moment. Stay with the partner if you can't enter. Be there for the recovery room transition.
VBAC — Vaginal Birth After Cesarean
A safe option for most people with one prior low-transverse cesarean. Success rates are 60–80%. Not every Louisiana hospital supports VBAC — provider choice and hospital policy matter enormously.
Doula role: Continuous support is associated with higher VBAC success. Help her find a VBAC-supportive provider in pregnancy. Validate the emotional weight — this birth is rarely just about this birth.
Section 7 — Perinatal Loss
Some of the births you attend will not bring a living baby home. You do not have to fix this. You have to be present with it.
The doula's role in loss
- Use the baby's name. Speak of the baby as a baby.
- Honor every choice: holding, not holding, photos, no photos, naming, not naming.
- Slow down the room. Loss births do not need to be efficient.
- Help create keepsakes only if she wants them — handprints, footprints, locks of hair, photos through Now I Lay Me Down to Sleep.
- Coordinate with the bereavement coordinator if the hospital has one.
- Follow up — loss support doesn't end at discharge.
If this work calls you specifically toward bereavement support, MHN offers a deeper Loss & Bereavement track. Talk to Maddy after Night 4 if you want to walk that path.
Key Takeaways
- Labor is four stages, and knowing where she is tells you how to support her.
- Protect the hormonal environment — dim, quiet, private — especially in active labor and transition.
- Every intervention has trade-offs. Use BRAIN to help her decide, never to decide for her.
- An unmedicated birth and a birth with an epidural are both valid. Your support doesn't change.
- When a cesarean is needed, your job changes shape — not value.
- When a baby doesn't go home with the family, presence is the work.
Before In-Person Day 1
Come to the in-person weekend rested, fed, and dressed to move on the floor. We will be doing comfort measures, position practice, and hands-on labor support all day.
- Read Field Guide pages 14–28 (Stages of Labor & Comfort Measures).
- Watch the Spinning Babies "Three Sisters of Balance" video (link in your cohort packet).
- Bring: yoga mat, water bottle, snacks, and a partner to practice on if you have one available. We will pair you up if not.
- Reflect: of everything tonight, what scared you most? Bring that question to the weekend.
Mary's Hands Network · ICEA-Approved Birth Doula Training · Online Night 2