The long labor
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 sooth the mother, especially helping her ease her busy mind or labor pain when we can.
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, tight ligaments -these can be relaxed with body work and things the mother can do herself or with help. Four specific techniques that are amazing.
Our bodies do matter. Women are designed for birth, its true, but modern life isn't exactly designed for women.
Long labors can be a result of the effects of cultural misunderstanding of human physiology. Hours in school desks and cars, for instance, and the list is too long to go through 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 women experiencing a long labor can overcome most of the reasons for long labor if it is about her body being in a bit of a twist from hours sitting or standing or being in a bit of a twist.
Start in early labor with this series of balance activities:
Sifting with the woven Rebozo (Mexican scarf) between contractions.
Partners, keep lifting the belly during contractions.
If or when a birthing woman is lying down, do an diaphragmatic release (abdominal release). This is a myofascial technique that a birth partner can do for a woman.
Bring ease into the body with these 3 Sisters of Balance.
Tight ligaments, weak muscles, a tight muscle 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.
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 description on this website.
Rotate baby to engage baby into the brim
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: The Abdominal Lift (described above for another purpose).
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.
Afterwards, 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. Its 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? Oh, yes! Every home and hospital room has a porcelain birthing stool. Sit for three contractions and then stand for one or more. That way you can keep swelling to a minimum in your tender places.
You've release 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.
Is early labor long but not painful?
A long early labor concerns many women. First of all, it takes a lot of attention and mental energy. Its easy to wonder if the next contraction will be the one to really do something. When to call the doula or doctor, when should the partner come home, what to do about other children? And when does the pain start?? We can tire ourselves out before labor even really begins.
Eating foods that are easy to digest, like simple soups, smoothies or yoghurt are 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 whose had a few babies already. Sensitivity to estrogen surges can bring on night-time Braxton-Hicks or practice contractions (a friend called these squeezies). A full moon or approaching weather front (barametric pressure drop) can eitehr bring on practice contractions or bring on a gradual, slow beginning. If you can eat and rest normally, getting good sleep at some point 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 chin tucking 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.
Is the labor long and painful?
The length of labor is a separate issue than the pain of labor. So I'm really talking about if long with unexpected strength and perhaps no or slow progress. That's 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 will need more than these basic suggestions to overcome a stall in labor. Some just need time. How do we know whether a laboring woman experiencing challenges or a stall needs technique 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 till she has a bad memory of you! 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 not contractions, sleep (without drugs if you can) and eat some oatmeal or other healthy carbs to restore a labor pattern.
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.
Techniques to overcome a stall or stuck baby
Rebozo jiggling (sifting)
Mother is on hands and knees with her helper behind it. Do the gentle sifting in between contractions. The helper stops sifting and stays still while lifting the weight of the baby during a contraction. This can be done for 2-3 minutes or from time to time during the labor. Its a wonderful way to relax without drugs. Done gently and symmetrically, it can be safe. Have the nurse or midwife check the baby's heart beat when you get in this or any new position before starting your technique. Most babies love the hands and knees position, but I want you to be paying attention to your baby and yourself above all else.
Standing Sacral Release (If in bed, do an abdominal release)
This is an easy comfort technique that relaxes tension in the sacrum allowing more freedom for pelvic movement. Any and all fascial release is suggested, if techniques are known. If the techniques are not known simply skip to the next technique.
See the video on this site. Have help doing this in labor. Its intense, it may feel good on your back, but some people will feel full in their head or chest. Have a doula or friendly your face helping you relax and breath through three contractions doing the Inversion. Do this for three contractions in a row and stay in place between contractions. Make sure your knees are cushioned and your elbows, also!
Pelvic Floor Release (also called Side-lying Release)
This technique is also best with "spotter" support in labor. This means, have a helper! Hold the pose for three contractions on one side and three on the other. It is very important, very important, do you want me to repeat that, its very important, to do this on both sides to let your pelvic floor become symmetrical and more loose. Otherwise, you haven't helped matters at all. If three is too much, try two on each side. Maintain the positions in between contractions.
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.
More about long labors:
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, sometimes 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. Help the baby to tuck the chin and then rotate the baby. See more in What To Do In a Posterior Labor
Is the baby in an ideal or anterior position? Yes? 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, no fetal distress, for instance, 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.
Active Labor is Long
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!
Long labors have a couple different patterns.
Long and steady: This is the labor pattern in which the contractions come at regular intervals, or fairly regular, like every 3-4 minutes with a little variation, and then every 2-3 as the cervix opens more than 7 cm, perhaps. Contractions may come in double peaks, a big one with a lingering second peak, like a hiker pulling a dog on a leash. And sometimes a cluster of big contractions may come and then some not so strong ones follow until the next big trio of waves return. These are contraction variations that tell us the uterus is working to fit the baby through the pelvis. The contractions are pretty steady, but the cervix opens slowly due to a close fit between the mom and baby.
Labor can be long without the cause being the baby's fit. For instance, did the woman have a pinch of her cervix removed in her past for testing? The scar tissue that resulted from this test could prevent the cervix from opening until the contractions have been super strong for hours. Then suddenly the cervix opens and can actually open from 2 cm to 10 cm in 15 to 60 minutes. That event has nothing to do with fetal position. I mention it to remind us all, its not always about fetal position.
Start and stop: Sometimes the uterus gets tired and stalls. The contractions are less painful and the mother can sleep. Sometimes this happens after the uterus has accomplished a goal, such as fetal rotation or engagement. Fetal rotation is labor progress even when the cervix hasn't changed or hasn't changed much. After the rest, the contractions will return with strength and the labor is very likely to advance faster and more like a "normal" labor, meaning, as it had been expected before the stall.
Strong and stronger with no descent: Sometimes the uterus is working so hard, really trying to get the baby to rotate and descend. The mother gets no break. We want to see if labor is advancing by bringing the baby lower, even if so gradually that it takes a few vaginal exams to notice, that's fine as long as mother and baby are fine.
Compare that to the baby that can't fit at all. The baby will be in the optimal, ideal or perfect position. Your efforts will have brought the baby to LOA and yet the baby remains high, where ever the pelvis was too small to let baby down. Can the pelvis be opened enough to let baby through? If yes, you will have progress.
If no, then, thank God there is the cesarean. It's telling the true difference that requires experience.
Is the baby known to be posterior? When labor is long due to the baby coming INTO the pelvis in the posterior position, we want to know if the baby will continue to fit in the posterior position or be able to rotate. We don't usually get to know this, so we can have an educated guess. If labor is moving along readily, we can assume it will continue to do so. If labor is slow, we can hope the baby fits. We can choose to be patient or we can try to rotate the baby.
Spinning Babies is the active side of patience.
Pushing Stage is Long
First of all, if the cervix is fully dilated and the mother doesn't have an urge to push, suggest a Rest Smart position and let her sleep! When she wakes, feed her!
Emotional support during second stage can help a woman trust 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 and teach the mother 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.
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 by an experienced midwife!
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!!
Is labor long because baby is too big?
Sometimes the baby gets stuck, actually, on the pelvis and can't get past. This can be looked at as if the baby can't fit, perhaps the doctor says the baby is too large. But if the baby is posterior, it isn't likely that the baby is too large, but rather that the baby's current head circumference is too large. There is a difference.
- Help the baby's chin tuck to get a smaller head circumference.
- Rotate the baby so the head is coming down from a different angle.
- Open the pelvis wider with mother's own positions (these activties and postures are called maternal positioning)
These are the three goals of the 3 Principles of Spinning Babies.
Other reasons for long labor
Size of baby. Bigger babies SOMETIMES need more time
Laboring woman has a pendulous uterus. Wearing a pregnancy belt, rebozo, or otherwise lifting and supporting the abdomen can bring the baby down with contractions!
Emotional safety needs to be heightened
Privacy needs to be protected, sometimes watchers, and sometimes even helpers, need to back off
Love and laughter
A need for doula CPR -- Comfort, Praise, and Reassurance given honestly and appropriately
Cord wrapping. A cord wrapped around part of the baby may lengthen the labor. In time, the uterus will come down and allow the baby lower. Fetal heart rate decels that are Not the late decel type (the more dangerous type) can be heard or seen, if recording the heart rate on paper, occasionally in labor. Cord wrapping, even around the neck, is not usually life threatening. Your provider will watch carefully to tell if its safe to wait, which it usually is. Meanwhile, have patience and let your uterus do the pushing during 2nd stage. The baby may stay high for a long time and then suddenly descend through the pelvis quickly in a few contractions at the end of second stage. Trust that your baby knows what to do here. Most of the time wrapped cords are not detected until seen.
Did the woman have a pinch of her cervix removed in her past for testing? The scar tissue that resulted from this test could prevent the cervix from opening until the contractions have been super strong for hours. Then suddenly the cervix opens and can actually open from 2 cm to 10 cm in 15 to 60 minutes. That event has nothing to do with fetal position. I mention it to remind us all, its not always about fetal position.