The other night, my husband (Joey) and I were discussing our close friend’s labor. For the last few days things have been slowly progressing. However, mom and baby seem to be doing well, so there has not been any intervention given. Joey asked me why some labors take longer then others. That is certainly a question that is asked frequently. There is a general idea that for first time moms, an average labor is anywhere from 12-18 hours (although this can vary tremendously) and during this time the care provider is able to see a pattern of uterine contractions that result in progressive dilation and effacement of the cervix.
What is the definition of labor dystocia aka “long labor”
What could cause labor dystocia?
Malposition of the fetus
“How to handle a long labor”
The mind/body connection can be very strong, and our emotions play a great deal in the way our body functions. Here is a short list (and by no means complete) of some emotional issues that may be preventing the mother from letting go and opening up during her labor:
-Someone present in the room is making the mother uncomfortable
As discussed above, the emotional state one experiences during labor can have a physiological effect on uterine contractions. If a woman is feeling unsafe or anxious her body will go into the “fight or flight response.” When this happens, the body is shifted into the sympathetic nervous system and adrenaline is released into the blood stream. The presence of adrenaline will interfere with the productivity of oxytocin - the hormone responsible for contracting the uterus. A lack of oxytocin slows the contractions down, or even possibly stop them all together.
The position one is laboring in could also have an effect on the strength and frequency of uterine contractions. According to the Lamaze Institute for Normal Birth Care Practice Papers, “When you walk or move around in labor, your uterus, a muscle, works more efficiently.” This can explain why many women feel find their labor rhythm more easily and effective when having the freedom to move about as oppose to lying in one position.
Sometimes CPD is caused by a small pelvis (this is not to be judged from the external dimensions of the pelvis- a small hipped woman could have a deceivingly roomy pelvis and visa versa), trauma to the pelvis, or malnutrition.
A very interesting article called, Pros and Cons of Epidural Analgesia During Labor: Recent Research , conducted a lengthy comparison of several studies about the risks versus the benefits of epidural usage and came to the conclusion:
In general, the studies/reviews analyzed indicate epidural analgesia as an effective means of pain relief during childbirth. The undisputed risks seem to be a longer labor, greater cost and higher chance of instrumented vaginal delivery, while the undisputed benefit found is effective pain relief.
1. Is mother ok?
If either of the first two answers is no- then medical intervention is best. Otherwise, the mother can continue to find pain management techniques that support her as she allows her body to open.
Keep well hydrated and nourished
(Here is the link to a past blog Eating During Labor . There are some suggestions of “labor friendly” snacks.)
Again, I am referring back to a past blog, 7 Tricks of the Trade for a Better Labor.
I want to take a moment to highlight a few of the 7 Tricks I refer to in the blog.
Change Positions Often!! Changing position every 20-30 minutes may help reduce the womans pain significantly as well as help resolve labor dystocia. There are several common positions for women to use during labor; side lying, semi seated positions, upright seated, standing and leaning forward, kneeling and leaning forward, all fours (hands and knees), childs pose, cat/cow, body circles, slow dancing, rocking on a birth ball, asymmetrical lunge in the upright position and squatting.
How change of position helps? Changing positions often gives the woman a chance to experiment and discover what positions seem comfortable and effective, but also allows the baby to move around in the pelvis, encouraging fetal descent and moving into an ideal birthing position. This is especially important in arrested labors where there is malposition (deflexed head, OP or the head slightly asynclitic) presentation of the baby or there is CPD suspected. For those experiencing “back labor” from a baby in the OP position, it is best to find laboring positions where the mother’s belly is facing downward, like cat/cow, all fours, and child’s pose. This will take the pressure off the back, alleviating some of the pain, but also allow gravity to rotate the baby towards the mother’s front into the anterior position.
Also, if the labor is slowing down, changing positions may help the mom get back into a rhythm that is comforting and calming while shifting the baby into the most advantageous position for passage through the pelvis. Once the baby is in an ideal fetal position, with adequate contractions, the baby’s head applies pressure to the cervix and this is what causes dilation.
Shower or Bath The feeling of warm water on your belly and back during labor can be a life saver! You may find that the water helps alleviate the pain and distracts you from such intense sensation. This would be especially good if you are having back labor. If the laboring woman is too tired to stand in the shower, place a stool or the birth ball in the shower or tub. Again, it is important for the partner or doula to monitor the temperature of the water and make sure it is not too hot. Because the bath or shower is so relaxing, I typically do not use this method of pain relief until the mother appears to be in active labor because it can slow labor down. However, if the early stage of labor is rather drawn out and the mother needs to relax, a bath or shower could be the perfect solution.
How the shower or bath helps? The warmth of the water on the mothers body can be mentally and physically relaxing. The water pressure can help alleviate muscle tension and back pain. The effects of immersion in water may be summarized as the following: bathing provides buoyancy and warmth, both of which often bring immediate pain relief, relaxation, lowering of catecholamines, increases oxytocin, and more rapid active labor progress. (The Labor Progress Handbook by Penny Simkins and Ruth Ancheta)
Birth Ball The Birth Ball is a large physiotherapy ball- typically 65 cm is appropriate for the average size woman. It can be used prior to labor to help alleviate back pain and promote an ideal fetal position. Many women are surprised by my advice to bring it to the hospital with them.
How the Birth Ball helps? During labor it is particularly useful to sit on the ball which promotes a natural swaying and rocking of the pelvis. This motion can encourage fetal descent and help alleviate lower back tension, as well as provide gentle support for the perineum. As an alternative to being on all fours, lean over the birth ball. This position encourages an anterior position of the baby and takes pressure off the mothers back. You can also place the ball on the bed, table or couch and lean over it while standing and swaying your hips. This helps the laboring mother to take advantage of gravity and again encourages fetal descent.
Massage I have met very few laboring women that do not appreciate a reassuring and relaxing massage. You do not need to be a professional massage therapist to give some one you love a little helpful massage. All you have to do is move into the massage with the intention of helping to release tight muscles and alleviate pain and most importantly, watch for the womans response. She may not verbally tell you if you are doing it right, so watch for her facial expressions and sounds.
How massage helps? Massage has been credited with helping to reduce pain, anxiety and fear by increasing endorphin levels in the body. Several of the common areas that the laboring mom may enjoy to have massaged are the lower back, neck, shoulders, hands and feet. Also keep in mind, the more relaxed you are, the less painful the contraction will seem. The more stressed you are, the more painful the contractions will seem. Final tip- be prepared with lotions or oils that smell good to you. Just the smell of the products may help relax you.
For more specific laboring positions and in depth explanation of labor dystocia, I highly recommend reading The Labor Progress Handbook by Penny Simkins. It is a must have for any professional in the childbirthing community!