Preparing for long labours
Amanda Patterson-Crowley
As Doulas, one aspect we must prepare our clients for, in particular first time parents, is the potentially long first stages of labour. My clients are always surprised when I remind them to prepare to labour at home, potentially for quite a while. We’re inundated with media that makes birth an emergency, not just in terms of medical requirement, but in terms of time. Waters broke! Rush to the hospital! Daddy’s not going to make it in time! The reality is, even if the birthing person plans to birth in hospital, they could be labouring at home for some time. So how do you prepare your clients, and yourself for a longer labour.
Manage expectations
It can be difficult to discuss because you don’t want to scare people! When you start talking about more than 12 or 24 hours, or in some cases of long prodromal labour, days, I’ve seen parents eyes go wide with fear. While I don’t want to scare them, I want them to feel prepared in these stages. In the cases of prodromal labour, it’s important to remind them that this can take some time, and there will be plenty of opportunities to eat and rest, and they should take them! This time is best used storing up energy for when active labour hits. Making themselves comfortable and practicing patience. First time parents especially will be anxious that labour has started, in particular if they have gone over 40 weeks, they may be being pressured to induce, or they may just be done being pregnant. So the mixture of anxiety, excitement and pressure builds the anticipation. This is natural, but remind them know to ease into it gently, don’t worry about being too strict on timing contractions, have a bath, do figure-8’s on their birth ball, sleep and do all the things that make them feel calm, centred and present.
Wait, what is prodromal labour?
If you haven’t come across the term prodromal labour, or latent labour - it is sometimes called false labour, but this is a misnomer. Prodromal labour is early labour, it is not false labour, it is very early labour. It often presents with irregular, softer contractions. Often the birthing person can even talk through contractions and there are long breaks. It can feel like very bad menstrual cramps to more intense labour contractions, and can start several days even before active labour.
If you get a call from a client who thinks labour has started, ask them to gently monitor their contractions, they don’t necessarily need to use an app at this point as that could even tell them they’re in active labour before they actually are. Keep you updated through chat or phone calls and remind them to rest, both parents! The birthing parents body is doing amazing work in this stage, the cervix is dilating, the baby is moving into position, the uterus is gearing up, hormones are preparing the birthing person and the best thing they can do is keep calm, and settle and honour this stage.
While they may want to let midwives know that their labour has started, if they’re planning on going into hospital, encourage them not to go in too early. Again, first time parents may feel excited and anxious to get to the hospital and be where they plan on birthing, but the transitioning from place to place raises adrenaline and will delay labour longer. If they are sent home, it may take some time for labour to pick back up. It can be difficult to know when to go in, hospitals will use a timed contraction pattern of 3 contractions in 10 minutes lasting 30 seconds or longer consistently. They may also want to do a vaginal exam to establish cervical dilation, if they are consenting to this (we won’t go into how a cervix is not a magical mirror for labour progress today). Set this expectation with your clients, explain that it could be a lengthy process and they may still be sent home.
Non-prodromal long labour
There could be other reasons that labour is long, when looking up reasons why labour could be long, the information out there is quite doom and gloom. It could be caused by anxiety, it could be caused by alternative positioning of the baby, it could be caused by lots of things - it could just be the way the parent births. As labour continues, it’s important to keep checking in with the birthing person to see how they’re feeling, if they’re in the hospital the midwives may want to monitor to make sure that the baby isn’t experiencing any distress. It can be difficult to pinpoint what is causing a longer labour, some contributing factors may be:
Irregular contraction patterns, long breaks, intensity of contracts felt in lower back could indicate that the baby is presenting back to back, or OP for occiput posterior. This can prolong labour as the uterus tries to turn the baby, plus cervical dilation can take longer as the part of the babies head that helps to open the cervix is not sitting on it. You can support the birthing parent with movement, comfort measures like massage and distraction (TENS or combs), moving into forward-leaning inversions and most importantly, belief and confidence that they can do this as long as they’re feeling safe to do so.
Anxiety and fear can slow a labour down, it may be a factor if the birthing persons personal life is unsettled, or they don’t feel safe with someone in the birth space, previous birth trauma, or even just fear and anxiety about the labour and parenthood! Communication and support will be key in moving them through the anxiety and fear, understanding what hormones are at play and encouraging oxytocin through massage, gentle considered and consented touch, brushing their hair, hugging and dancing.
Cervical lip, big baby, small baby and many other reasons! None of which mean that there is an emergency. It’s important to listen to the birthing person about how they’re feeling. They are likely to know if something doesn’t feel right and needs to change before even any external monitoring could pick it up. Keep checking in, honour their feelings and move at their pace. This can be difficult in a hospital setting if there is monitoring in place. If medical teams start to move quickly, slow things down, advocate for the space to make decisions about how to move forward, and continue to offer belief and encouragement.
Most importantly, listen to your birther. They will tell you how they’re feeling. Build up this trust and communication with their body in the lead up to labour.
Managing long labours as a Doula
Long labours can be tricky to plan, in some cases you may be showing up to the labour early, assessing and then heading back home to sleep or continue your own day, in others you will stay away until you feel like it’s the best time to arrive. When planning with your clients be sure to be clear about how you would manage your time during a long labour, when the best time for you to arrive is, and the need for you to rest so you are best able to support them. If you’re working with first time parents, let them know that you may not come rushing as soon as labour is started, you may be waiting for signs that labour is moving into active labour with questions around the pattern and regularity of contractions, the wellness of the birthing parent and even the sounds the birthing parent is making in the background on the phone. You may want to show up earlier than that to support them in any transitions, this is up to you and should be a part of your plan with them! For the most part though, the early stages are the best time for you to leave them to it, this stage the parents are slowly turning inward, preparing their space and building oxytocin, you may be a bit of a third wheel!
Once you’re there, as you’re supporting the birthing person through the labour you could play an active role in keeping them going! They might start feeling tired, they might start saying that they can’t do anymore, they aren’t doing a good enough job or they’re failing. Keeping both the birthing person, and their partner going as long as they’re feeling safe is important. Reminding them that their body is doing important work, that they are progressing even if it doesn’t feel like it, that while they feel all is going well they can trust that their body and their baby is moving the labour forward. When planning the birth, I have often discussed when we take “tapping out” seriously. If the birthing person is saying they can’t continue, do we act the first time they say it? Or do we encourage them to keep going and reassess after ten minutes, or 3 contractions. Plan this out and stick with it, unless the birthing person is saying that something is wrong, or they’re becoming very stressed - this could be a sign of something else happening.
Keeping the birthing person comfortable and feeling healthy and well can help them continue. Continual encouragement, reminders that their body is doing amazing work, they are capable of continuing as long as they feel they can. Making sure they are eating and drinking and peeing throughout labour! Massage, aromatherapy, a bit of pampering will all help keep them comfortable.
Birth is not linear, we do not progress through labour on a perfect curve, it can slow or speed up, cervixes can dilate slowly or all at once. Respecting the individuality of labour progression, honouring the birthing persons needs and encouraging them to listen to their body and share their needs is important.
Don’t forget, find time for your own rest. The old adage, you can’t pour from an empty cup. Take frequent breaks, see to your own comfort, eat and drink, dress comfortably and step away for rest when you need to.