Help baby engage in labor
A baby can not get through the pelvis if the baby can't get into the pelvis.
Lack of engagement is a common issue for the woman who labors but the baby remains high in the pelvis. A common obstetrical solution is to do a cesarean. There are a few simple techniques that can be done. Some are easy to do, some are challenging. But once they are done, the labor is very, very likely to progress. And sometimes, the labor will even finish quite quickly with suddenly less pain than when the uterus was overworked trying to get a baby into the pelvis for days of labor. In fact, learning how to help baby engage can save hours and even days of labor. Check this out.
What does labor look like when the baby isn’t engaged?
Early labor can go on for a day or two or three. Sometimes the woman thinks her starter is broken. This is because the labor can start and stop as the baby tries to get into the pelvic brim. Women may not dilate beyond 3 cm when the baby remains high.
Othertimes, labor seems to begin and progress normally until a labor stall occurs in active labor. So, in this case, labor started without stops and starts. A labor stall is when labor slows and stops, though some contractions may come without strength. OR, contractions are strong and close but the cervix isn't opening past 6 or 7 cm, usually, though this could occur at 10 cm in the case of lack-of-engagement. The baby remains high during the stall in this case. When baby is not engaged the baby is -3 or -2 station. (If baby is -1,0, or +1 station, then the baby is engaged but stuck in the midpelvis and you would do a sidelying release for that scenerio.)
Generally, contractions can be quite strong, long, close together and painful until the baby makes it into the brim (when baby truly has to navigate the brim to get into it).
Once the baby engages, perhaps because the baby rotated and dropped into the pelvis, then the labor often seems to stall. In this case, this is no problem. The uterus is resting. The mother can rest too, as long as her and baby's vital signs are good.
Once the uterus is rested and the mother fed and slept, the labor will pick up. It won't seem as painful as it starts up again and the contractions will be more manageable. Then they will get closer and longer lasting and the cervix will open in response this time. Things will be more predictable and as expected when the baby's chin is tucked and the head fits the pelvis better.
In Labor, techniques to help the baby engage
We'd focus on engagement if baby were high, the baby were at -2 or -3 station AND the labor didn't progress within a few hours of regular contractions. We could also try these techniques if the early labor felt strong and had a start and stop pattern (with strong contractions).
Ten contractions in a row doing the abdominal lift
Sitting on a firm birthing ball and doing rather rapid hip circles (hoola hoops) or figure "8s"
Open the pelvic brim with Walcher's "Opening the Brim" Position (only effective during contractions)
Open-knee stretch in the pool (Inverted Walcher's in the pool during 3 contractions)
Again, helping baby rotate to the LOT, LOA, or OA fetal positions so the head fits more readily
Helping the baby tuck his chin with the abdominal lift and with circles on a birthing ball
What does labor look like when the baby isn’t engaged?
Early labor can go on for a day or two or three. Sometimes the woman thinks her starter is broken. This is because the labor can start and stop as the baby tries to get into the pelvic brim. Not all unengaged labors begin this way, but it is quite common.
Contractions can be quite strong, long, close together and painful until the baby makes it into the brim (when baby truly has to navigate the brim to get into it).
Women may not dilate beyond 3 cm when the baby remains high. Once the baby engages, perhaps because the baby rotated and dropped into the pelvis, then the labor often seems to stall. In this case, this is no problem. The uterus is resting. The mother can rest too, as long as her and baby's vital signs are good.
Once the uterus is rested and the mother fed and slept, the labor will pick up. It won't seem as painful as it starts up again and the contractions will be more manageable. Then they will get closer and longer lasting and the cervix will open in response this time. Things will be more predictable and as expected when the baby's chin is tucked and the head fits the pelvis better.
Problems after engagement if baby’s head position wasn’t optimal
If the baby drops but the chin remains up, though the baby is coming down, the labor might still take a long time, depending on pelvic shape. We may then have to help open the midpelvis (ischial spines) and outlet.
The lunge is a wonderful technique for helping the baby when labor stalls at 0-station or below. The hip press is another.
If the baby drops but the head is tipped, as if the baby is listening to the outside world, in an asynclitic position, then the labor will remain long. Opening the midpelvis the head to pass through helps (lunge, sidelying release). See the article on asynclitism in Baby Positions.
Conclusion
Babies naturally engage in the pelvis when the broad ligament is soft enough and the brim open enough. Fetal chin tucking and coming down from the mother’s left side helps more babies fit more mother’s inlets.
Generally, we hope for flexion and rotation before engagement. This is most important when we find baby in the posterior position and high after 38 weeks.
Work on Balance before working on rotation and descent. Though, sometimes we have a time issue, as when a woman's membranes have released and when her provider has a time limit for her labor. Descent from a non-optimal position may have additional challenges that may be met with maternal positioning and activities in labor.
Doing Balancing activities first will ease the coming active phase of labor.
