What to Do When… (In Labor)

Labor is long

The art of the long labor involves helping a mother keep up her morale while addressing her body’s needs for marathon activity. We can help soothe the mother by helping her ease her busy mind or labor pain when possible. It is important to address the reason for the long labor. When the issue is in the tissue there is something we can do. Tight muscles and tight ligaments can be relaxed with body work and things the mother can do either by herself or with help. Check out the Fantastic Four for specific techniques to aid this relaxation.

Our bodies do matter. It’s true that women are designed for birth, but modern life isn’t exactly designed for women. Long labors can be a result of the cultural misunderstanding of human physiology. Hours in school desks and cars, for example, are postural restrictions that were not in the design plans for sacro-ischial joints or the psoas erectors! With trust, patience and a bit of a “Balancing Act,” a woman experiencing a long labor can possibly overcome the effects of hours sitting or standing and achieve labor progress.

Early labor is long but not painful

A long early labor concerns many women. First of all, it takes a lot of attention and mental energy. It’s easy to wonder if the next contraction will be the one to really do something. When should you call the doula or doctor, when should your partner come home, what should you do about the other children? And when does the pain start? With all of this on your mind, you can tire yourself out before labor even really begins.

It’s important to eat! Eating foods that are easy to digest, like simple soups, smoothies or yogurt are a few favorite labor foods. Toast is a classic, but not too nutritious, so don’t forget root vegetables and an easy-to-digest protein. I craved a salmon sandwich and enjoyed salmon for the first time in my life during the early part of my second labor! A long early labor might occur for a woman who has had a few babies already. Sensitivity to estrogen surges can bring on nighttime Braxton-Hicks or practice contractions (a friend calls these squeezies). A full moon or approaching weather front (barometric pressure drop) can bring on practice contractions or cause a gradual, slow beginning. If you can eat and rest normally (i.e. getting good sleep at some point in each 24-hour period), things are generally fine. Keep in touch with your birth attendants and relax. A long early labor for a first-time mom or a VBAC mom may indicate a need for engagement. A long early labor sometimes means that this baby needs to rotate some more before fitting into the brim of the pelvis.

Is baby engaged? Has baby dropped? Read the article on engaging baby in labor for more information on how to help your baby get into the pelvis so that labor can progress. See more about what to do in The Three Principles.

You’re having back labor

Tight ligaments, tight or weak muscles, or the baby’s position may be the cause of back labor. Some short-waisted women get back labor. The baby is longer than the mama’s torso, so to speak. We want to reposition the posterior baby’s head towards the cervix.

If you know that the baby is facing forward (posterior presentation) or you have back labor in any case, there is a simple technique that works wonders. When you can anticipate a contraction coming (contractions have to be somewhat regular), begin an Abdominal Lift, also called a Belly Lift, and hold it during the contraction. Let go of your belly in between contractions. Repeat ten times as described on the Abdominal Lift page on this website. We expect that ten Abdominal Lifts (with a tucked pelvis during the contraction) will shift the force of the uterine action (contraction) from your back to your cervix. The baby is angled better as well. With success, the cervix will begin to dilate.

Afterward, for the next several contractions, stand with soft knees and lean forward. Let your knees be soft, not locked straight. Let there be a little movement in your knees, to help you be more intuitive with your body signals and fluid in your labor movement. Softness lets your pelvis move better. Leaning forward encourages babies to rotate and labor to progress. Wear a pregnancy belt if your belly hangs over your pubic bone.

Keep working with Gravity. When you do feel the need to move, get up. Move around. Be vertical. It’s surprising how often women find being up and moving more manageable than lying on their hips or their back in bed. Need to rest again? How about sitting on a birthing ball or a birth stool? Don’t have a birth stool? Sure you do! Every home and hospital room has a porcelain birthing stool. Sit for three contractions and then stand for one or more. This will help keep swelling to a minimum in your tender places. You’ve released some constriction by bringing your body into better balance. You are being mindful about gravity-friendly positions. Now you may need to move your pelvis to help your baby move down.

Labor is long and painful (i.e. you’re experiencing a stall in labor)

The length of labor is a separate issue than the pain of labor. A long labor with unexpected strength and perhaps no or slow progress is called a stall in labor. Its only a stall if after 4 cm, though we want to pay attention to why labor stops if before 4 cm, too, especially if the water broke.

Some women just need time in labor. But how do we know whether a laboring woman experiencing challenges or a stall needs techniques or just time? Do we want to wait and see? Usually the waiting gets done in a hurry and there isn’t time then for techniques, as in, “I’ve had it, give me the epidural now!” So if the mother doesn’t want to do techniques, fine. Don’t push her. But if she needs a little encouragement, try love! In labor, there is a series of techniques that solve most labor stalls, especially in the presence of contractions:

If no contractions, sleep (without drugs if you can) and eat some oatmeal or other healthy carbs to restore a labor pattern. Follow these up with a rest in a Rest Smart position, or when up, standing with knees soft (not locked) and leaning over a friend, a counter-top, etc. The techniques to overcome a labor stall differ a little if you are in bed or if you are able to be up and moving. If you are in bed, due to sickness, high blood pressure or an epidural, use the Roll-over as best you can.

You’re having a long early labor with stalls and starts

The mother may feel that her labor is going. Contractions may be strong and close, or mild and close together. But then they slow down. Then, later, they start up again.

Is it labor or is it only a promise? It hurts so it must be labor, right? Oh, but the cervix isn’t opening, so it must not be labor… Which is it? The mother’s body may be ready, but sometimes with a posterior baby, the baby isn’t fitting into the pelvic brim. Labor wants to start, but the uterus just can’t get baby down into the pelvis. We need to help the baby to tuck the chin and then rotate. See more in What To Do When…In Labor.

Is the baby in an ideal or anterior position? Then let’s get the chin tucked! Are contractions stopped or mild for now? Rest and then eat. Wait for contractions to return. Once baby is engaged, the uterus may require a rest. As long as mom and baby have no clinical signs of trouble or fetal distress, a good nap is just the thing to protect the labor later. Go for the “snore.” Just “resting the eyes” isn’t enough to protect the stamina needed for later. After a good snore, have a bowl of oatmeal. The uterus will pick up again once rested and fed. If baby has rotated and/or engaged, labor will start again.

Your active labor is long

A first-time mother can expect her active labor phase (the part of labor that opens her cervix from 4 cm to 10 cm dilation) to last from 12 to 24 hours. If labor is shorter, great. But its not helpful to assume labor will be short because her mother’s labor was short or because she has a great attitude, though those are certainly happy things. Labor can be longer than expected when:

Baby has come into the pelvis in the posterior position

The posterior or anterior baby has the chin up a bit

The mother isn’t nourished, rested, or doesn’t feel safe/uninhibited in her location or with the people with her, or

The baby is large for the mother’s pelvis.

Again, we want to protect the health of mother and baby with food and rest for the journey. She doesn’t have to be constantly reminded to eat and drink, but watching the clock discretely and making sure she’s eaten a 1/2 cup of food or so every couple of hours is a minimum once she’s passed 6-8 hours of labor. Eat during a lull. Sleep during a lull. Emptying the bladder is important, too. If baby remains high, ask the nurse or midwife (if she isn’t already) to monitor how much urine is actually coming out. Monitor the “ins and outs” of labor! Emotional support that is appropriate to the mother’s needs is quite important!

Your pushing stage is long

First of all, if the cervix is fully dilated and the birthing person doesn’t have an urge to push, suggest a Rest Smart position and let them sleep! When they wakes, let them eat! Emotional support during second stage can help accept the downward pressure sensations and reduce resistance to letting the baby descend and come past the rectum and onto the perineum. These can be overwhelming sensations and reassurance and a practical attitude are helpful.

Let the urge come on through natural body sensations when and how to push. If necessary, change positions to encourage the urge and the opening of the pelvis. Gravity works.

Opening and moving the pelvic joints is helpful during a contraction. If baby is low, someone helping can see the baby with a push or knows they soon will (baby is low, right?) then the best pushing position is KNEES TOGETHER with heels outward and toes aiming towards each other. Try it for three contractions in a row and see what happens!

Time is less important than good breathing habits. Holding the breath frequently gets to be harmful after a while. When baby is getting good oxygen exchange between the contractions helps baby’s stamina. An experienced midwife and or physician can help a woman through a long second stage. I’ve heard of 24-hour second stages with active pushing stages of 5-8 hours with great outcomes. But time is less important than listening to the baby. A long second stage needs skilled help!

Nutrition is almost always easier during 2nd stage than 1st stage (dilation) so offer food again. Resting is an option. And changing positions frequently is smart. If its not working, try something different!!

You have a swollen cervix

Too often a swollen cervix sends birthing women to the operating room. Here’s what to do about it. The cervix opens like an oval ring getting wider and eventually more round as the baby’s head presses down during fetal descent in labor. Effacement of the cervix is when the cervix gets thinner. Thinning out helps the cervix to open. Because we expect the cervix to get thinner, it can be alarming when the cervix stops opening and swells.

Swelling with contractions and without progress is a sign that labor progress has stopped or stalled. The swelling may be equal all around, but is usually unequal.

Swelling in the front of the cervix is common and usually resolves with time for flexion and molding. Sometimes help to flex the baby’s chin is desirable!

Swelling all around is not so common and usually means the baby may need more help than simply time.

Swelling on one side indicates that the head is asynclitic. Do the sidelying release for both legs for any of these, but particularly for this one! Afterwards, lay on the side that the swelling is thicker.

But it doesn’t mean that the baby won’t be able to fit once he or she, often needing our help, can find their way through the lower pelvis. The uterus continues to contract, trying to correct the baby’s position. The baby may be

Occiput Posterior

Asynclitic (tipped head)

Deflexed (head is in a military presentation or has an extended chin)

The baby may or may not be able to fix this spontaneously. Time without helping baby to fit may only stress the womb or baby. But when we understand the need, we can begin to address the issue more intelligently. Necessary changes include flexion, rotation to a better position, and/or molding better to fit.

Interventions

When the cervix is swollen, the knee-chest position helps. We can also apply a small amount of ice in the finger sleeve of a glove and apply to the cervix. Another option is to put Homeopathic tablets of Arnica and or Cimicifuga on the cervix and give orally according to directions. It must be the homeopathic versions of these herbs to be safe and appropriate. Quiet the environment and let the birthing mother rest on her side in a deep tub of water between 94 and 98 degrees Fahrenheit. A mature and soothing woman to reassure her and help her doze helps her mind calm down and the cervix to open.

An experienced doctor, midwife or, possibly, nurse (if local protocols allow) might be available with skills to flex and rotate the baby’s head if these things don’t work. I haven’t found this to be a common need in these situations, but it shouldn’t be forgotten in cases where its appropriate. An epidural may not solve the swollen cervix, but may be offered in the hospital.

A cesarean is offered or recommended when the labor doesn’t resume within two hours. Yet, this situation can easily take that long or a bit longer to correct itself using the above position changes and ice. Note: A stall is not necessarily CPD A stall in labor is when contractions come strongly but the cervix doesn’t continue to dilate. (A lull is when contractions are milder.) CephaloPelvic Disproportion (CPD) means the baby’s head is disproportionately big for the mother’s pelvis.

A stall in labor with a swollen cervix is NOT IN AND OF ITSELF reason for a cesarean. Swollen cervixes will become unswollen when the head shifts and allows circulation. We can also move the mother to improve circulation. The cause of the stall with swelling is often a need for further flexion and rotation for the baby to line up with the lower portions of the pelvis. But we can not forget fear or disturbance of the birthing environment as a causative factor. See my article Will Baby Fit? to understand the signs of a labor in which the baby can’t fit, and to see the difference between a stall in labor and signs that baby is really too big for the pelvis.

You have an early urge to push

I believe it is uterosacral ligament tension that causes the early urge to push. There may be deflexion (chin up) or Occiput Posterior presentation with that tight or twisted ligament. To help, follow the 3 Principles!

Principle 1, Balance

We want to “make room” and “add balance” first:

A Forward-leaning Inversion through 3 contractions, followed by a sidelying release.

A pressure point massage around the edges of the sacrum, and again around an inch margin from the sacrum’s edge, helps mobility.

Finally, some women will benefit from a sacrotuberous ligament release, which is quite specific and intimate, even though external.

Principle 2, Gravity

Knee-chest with the mother’s chin up, tongue out and panting reduces her body’s spontaneous urge to push.

Principle 3, Movement

With the same knee-chest position of the mother, add a rebozo scarf over her bum and “shake the apple tree.”

Interventions

A knee-chest position reduces pressure on the cervix and the posterior portions of the pelvic area including the uterosacral ligament. This can reduce the urge to push.

Extreme panting: I learned this technique in The Yoga Journal. The woman puts her chin up and sticks her tongue out as far as she can and pants through the contraction. This posture with the tongue out prevents downward pressure on the cervix. It’s awkward, but it really works! As a doula or midwife, I’ve joined the birthing woman with this technique to help her feel more comfortable.

We may use homeopathic tablets of Arnica and or Cimicifuga orally according to directions, or on the cervix. These must be the homeopathic versions of these herbs to be safe and appropriate.

Quiet the environment and let the birthing mother rest on her side in a deep tub of water between 94 and 98 degrees Fahrenheit. A mature and soothing woman to reassure her and help her doze helps her mind calm down and the cervix to open.

An experienced doctor, midwife or, possibly, nurse (if local protocols allow) might be available with skills to flex and rotate the baby’s head if these things don’t work. I haven’t found this to be a common need in these situations, but it shouldn’t be forgotten in cases where its appropriate.

The premature urge to push can be a real annoyance. Pushing on a cervix that isn’t ready may tear it, although that’s rare. Pushing early sometimes causes cervical swelling. We can move the mother to reduce her urge to push until her cervix is fully opened (or so soft it slips over the baby’s head if it is almost fully open). A knee-chest position is often helpful, though panting with the tongue out may still be needed!