One of the biggest concerns clients mention when hiring a doula is the desire for a short labor. Did you know there are things you can look into prior to labor that may help shorten your labor time? That’s right, you can help facilitate a potentially easier birth. It’s obviously not a guarantee, but education equals empowerment.
Let’s start with some background on labor
Labor Dystocia, the term formerly used for a labor that stops progressing, is defined as a labor that presents in an “abnormal progression” of dilation during the second phase of labor between 4-10 cm, or limited change in baby’s station during the labor process. This led to many labors being deemed “failure to progress” for a lack of consistent progress in labor. Most obstetricians were trained to look for labor to progress in compliance with Friedman’s curve- a graph developed in 1955 by Dr. Friedman which showed the average amount of time it took first time laboring people to dilate by centimeter. This was determined after studying 500 caucasian women in New York City. If it is not clear to you why this is a scientifically less significant study than should have had influence over generations of obstetrics, head over to EvidenceBasedBirth to read more.
One of the important details we want you to note is in 2010, new research found that most people do not tend to have regular dilation until after six centimeters. This led ACOG and the birth community to redefine “active labor” as starting at 6 cm. Anything prior to this, should not be considered failure to progress, or labor dystocia, as the labor pattern has not really established itself yet. Knowing this fact may help you advocate for more time for early labor to hit active labor rather than interventions or a cesarean delivery.
What causes labor to stall?
There seem to be a few factors that cause labor to progress slowly. Some refer to this as the 4 P’s. We are going to give you 5.
Pelvis– The size, shape, inlet and outlet of your pelvis can all play a role in the baby’s decent through and out of your body. If you were malnourished in your youth when your pelvis was growing or if you had an injury to your pelvis, the baby’s decent may be impaired. It is important to note that while some providers claim the ability to determine your pelvic potential, there is limited evidence to support this belief and in fact pelvic telemetry would need to be done via MRI or under general anesthesia due to how painful manual measurement would be.
Passenger- This refers to the baby. The baby’s position, tuck or extension of their chin, tilt of their head and/or limbs near their head can all cause the passage out to be more or less laborious (pun definitely intended).
Power- The strength and intensity of your contractions are the power behind getting the baby out. The muscles of the uterus move throughout the labor process, collecting at the top of the uterus to thicken the fundus.
Psyche- What is happening in your mind plays a role in how your labor progresses.
Provider- This is the person (and location) you hire to SUPPORT your birth. Making sure you have hired someone aligned to your goals and beliefs has a huge impact on your birth outcome.
What can you do to help labor progress?
Let’s consider what you can control about each of the five P’s
Pelvis– You can’t change the size, formation or injuries to your pelvis, but what you can do is ensure the space you have is as well prepared as possible. Chiropractic adjustments can ensure all the bony structures are well aligned in preparation for the baby’s decent. We also suggest reaching out to a pelvic floor physical therapist to ensure there are no soft tissue issues which might slow the baby’s decent. These two modalities contribute very positively to the health and comfort of pregnancies.
Passenger- Many families have found that chiropractic care helps the baby find a favorable position, but if they find themselves in a less than preferred position, Spinning Babies can be an invaluable tool. Our favorite techniques are the psoas release, Miles Circuit, Side-lying Release and this routine for breech babies.
***We also want you to know that Reading Hospital supports vaginal breech deliveries.
Power- During labor, if there is a “stall” it may be the baby’s position. It is important to note that sometimes the contractions space out and are less powerful if baby is in a less than ideal position, so doing some of the afore mentioned positions may help progress labor, whereas Pitocin may force the baby deeper in the pelvis in a malposition. These changes in position and time give the baby the chance to change how they are coming down. An alternative to Pitocin is to use a breast pump to stimulate your natural Oxytocin levels. It does take longer, so be prepared for a slow, gentle build of an hour or more. If you do elect for the use of Pitocin, you might consider the research in this study which found the body does not show the full response for 30 minutes or more, meaning you may not want to see increases any more frequently than every 30 minutes.
Psyche- Have you heard of the placebo effect? This is where the belief that treatment will have an affect on you causes the effect without any medication involved. How about the Nocebo effect? This is where the expectation of a negative outcome can be created by the power of thought. Your mind is very powerful in how you perceive your labor experience. It will determine how you experience the intensity of labor. If you expect it to be painful, it will be terribly painful. If you expect it to be a powerful workout, it will fell like the most badass gym day you ever experienced. If I asked you to lift a 3 pound weight, I’m sure you could do it. Over time, lifting that weight would start to feel challenging, you might even say it was painful. What you wouldn’t do it fear lifting that weight because you know it’s just the sensation of a muscle contracting and that feeling is powerful work which is strengthening your muscle. Labor is a challenging experience, but it is not suffering. You can do hard things. Keep your mindset focused on one single moment at a time.
Provider- Imagine the impact of having a provider who expects your labor to fail or who tells you your pregnancy is high risk for nine months. Who you hire will impact your labor experience more than anything we have mentioned above. If they believe your labor will fail, that your baby is too big, that your body is deficient or that birth is scary and dangerous, it WILL impact your experience.
On the other hand, imagine working with a provider who believes in you. One who says things like, “I’m confident you can have this baby the way you desire. I’ll support you in your goals. I believe in you. YOU are the BOSS.” Imagine working with a provider who gives you absolute risks rather than relative risks. Which provider do you want to work with? Someone who says, “We should induce you at 41 weeks because your risk of still birth more than doubles at that point?” or the one who says, “Research shows that at 40 weeks your risk of miscarriage is 0.33%, at 41 weeks it is 0.8% and at 42 weeks it is 0.88%. This means you have a 99.22% chance that everything will be fine if you wait for labor to start on it’s own, but it is my job to be sure you are informed about the risks and have the chance to ask questions.”
Since this is the biggest decision you will make, we made a full post dedicated to the topic. Read more about how to choose a provider you trust here.
Labor has no clock and we can’t promise doing any of these things will make it go faster, but what we do know is that being in the right place, with the right people, feeling safe, secure, undisturbed, supported, heard, having good physical and structural alignment and feeling confident in yourself will make the process go more smoothly. We wish you the very best of luck and remember, if you want a doula to be by your side through it all, we’ve got your back.
