Tips for Labor Progress

If labor is progressing on its own, don’t try and make it progress more. It is distracting and leads you away from your natural process. If, on the other hand,

  • Labor seems not to start well (seems to start and stop, or just doesn’t pick up),
  • Pauses in the middle,
  • Contractions are strong without bringing dilation,

You may benefit from some of the following suggestions.

 

Pre-Labor or Early Labor when contractions are irregular

Length 20-40 seconds but not consistent

When baby isn’t fitting well, these contractions can be 60-120 seconds with no dilation. One sign can be that the labor pattern is erratic. But don’t make an assumption, please! It can be difficult to tell this situation from transition without a vaginal exam. See Comparing OA and OP Labor Patterns for more details.

In this situation, these can help:

Try and go about your day as normally as you can. Take a nap. Don’t forget to Rest Smart!

Is the abdominal wall loose? Does your uterus hang forward and make a crease underneath it at your panty line in front? Then use a pregnancy belt or a Rebozo to lift your uterus and allow the baby to come down on your cervix. Wear it until the baby is out to prevent a stall in labor after the head is born.

Check in with your provider(s) if special needs present.

 

Early Labor when contractions are regular

Frequency 4-10 minutes apart; length 20-45 seconds

Bloody show possible

  • Relax the abdomen with the same things listed in Pre-Labor. Wait on the tub.
  • Maintain regular daily routine (special considerations if water broke). Eat every two hours and drink water, electrolyte drinks, a little grape juice or hibiscus tea (for example) each hour.
  • Rest Smart when tired, walk or slow dance, lean forward by, for example, washing the floor on your hands and knees.
  • Use Gravity with the Abdominal Lift.
  • Hands and knees or kneeling over the back of a couch or hospital bed. Or, kneeling on pillows and resting your arms in a comfy chair.
  • Move: Lively hula-hoop circles on the Birth Ball for 20 minutes.
  • Stand and lean forward in the shower if sitting is painful, do pelvic circles while standing.
  • Check in with providers to let them know potential for labor to bring you to the hospital (or them to you, if having a home birth). Call the doula! Doula-supported labors are statistically shorter than labors without one.

 

Active Labor – beginning about 4 cm

Frequency 3-6 minutes apart, from start to start; length 60-75 seconds from start to finish of the majority of contractions

  • May need quiet, dark, privacy
  • Continue to Rest Smart when tired and use the relaxation methods in Pre-labor. Massage between contractions.
  • Rebozo sifting for serious relaxation.
  • Movement: Walking can help contractions continue to come. Be sure to eat, too. Slow dancing is more for relaxation and not that dramatic for progress. Circles on the Birth Ball. Lunge for one-sided pain, asynclitic head after 4 cm, or just progress when slow.
  • An inversion of one type or another, your preference, may help, followed by the Trochanter Roll (Walcher’s Maneuver) if the baby isn’t in the brim before that. See the article for details on how to do it.

Confined to bed?

Some providers persuade or direct all their moms to stay in bed during labor. Sometimes a woman’s health is such that she has to stay in bed. Keep rotating the pelvis. Lay on your left side with a pillow between your knees or lift your right knee high up on a stack of pillows and shift your left hip back behind you, so to speak, so your belly aims in the mattress. Use pillows to support what needs supporting.

Switch to your right side and try each of the variations. If you can kneel and lean over a birthing ball or the raised head of the bed, do so for 30 minutes between sides. Each thirty minutes change positions.

If your labor starts progressing rapidly, don’t worry too much about position changes for the purpose of labor progress. On the other hand, if labor doesn’t continue to progress, try and keep your back straight, not curled!

 

Active Labor – 5 cm (or 4-6) “Five Centimeter Slump”

Frequency 3-5 minutes apart; length 60-85 seconds

If you cope through 5 cm, you’re likely to have a natural birth!

  • Relax your involuntary muscles as described before. Or, if you have a loose, pendulous womb, wear the pregnancy belt during your entire labor. Rest Smart when tired.
  • At any time in active labor (through the next three described phases) you can
  • Afterward, you will probably want to sink in a full tub or take a warm shower to mentally relax after those three techniques which can be challenging this far into labor, but amazingly effective.
  • Gravity: Abdominal Lift and Tuck as before, do for 10 contractions in a row, resting between. Lunge for 6 contractions on each side.
  • Showering is very useful, maybe while sitting on birth ball, or leaning forward.
  • Feeling dispair? Or, labor is just very intense?! Time for a tub bath.
  • Stand and hang on to your partner’s neck. Stand and hang on to a sheet thrown over the bathroom door-tie a knot in one end and throw the knot over the door, then shut the door with the knot on the other side. Now the sheet won’t slip off the door and you can hang on the sheet and bend your knees and move to the contraction.
  • Movement: Slow dancing or slow dancing in the shower with the wall, or grip bars, while partner sprays your back with a warm stream of water from the shower hose.

 

Active Labor – advanced 6-8 cm

Frequency 3-4 minutes apart; length 60-85 seconds

  • If not at birth site, now is a good time to go!
  • Balance: as before, plus, relax the throat by “cooing.” Deep, low tones are usually better than high-pitched tones to relax the throat.
  • Gravity: Lots of moms like to be low to the ground…and they feel grounded with their knees deeply bent. Kneeling on the floor while leaning forward, for instance, or crouching down like in this photo.
  • Need to speed things up? Sit on a toilet for three contractions, then stand for 3, and then sit for 3 contractions again. Shower or tub. Birth Balls are rarely desired this late in labor, but if so, go for it.
  • Movement: Lunge, if you haven’t before, or try again for 6 contractions on each side. Walking can still be helpful, but may not be practical. You will know what you need.

 

Active Labor – Transition 8-10 cm

Frequency 2 1/2-4 minutes apart; length 75-120 seconds

Bloody show likely, even if seen in early labor or before labor

  • Balance as before: Inversions are a common success for the stall in a posterior labor.  Use of a doula and face-to-face support is commonly appreciated. Loud moaning to a rhythm and a cool cloth can also help.
  • Gravity: Standing and leaning forward, Rest Smart when in bed. Birthing sling. Stand and hang on to the Rebozo or give the squat bar a try through 3-6 contractions.
  • Movement: Lunge, holding Rebozo or sheet and straightening back. Bending knees with contractions and moving freely. Baby still high? Trocanter Role with Walcher’s Maneuver. Pelvic floor release.

 

2nd Stage – Pushing or Releasing

Frequency 3-5 minutes; length 45-75 seconds long

  • Balance: Be upright, with your back long and extended. Don’t curl your back. When labor is not progressing readily, let your back be straight the way it naturally wants to lengthen. Sit up on a toilet (the porcelain birthing stool), lay on your side with your back arched instinctually, or stand and lift your arms to hang onto something sturdy above you.
  • Relax well in between contractions. Let the contraction get started before pushing voluntarily. If you need to push, use exhale pushing to conserve strength or mental stamina. At the end of each contraction, take several deep cleansing breaths. Smile and feel the joy. Make deep vocalizations, vowel sounds or roaring as desired. Kiss your lover. Know that your baby is helping you by pressing that pain out of your body. Work as a team. Let the baby rock back and forth in your pelvis; this relaxes the tissues in the perineum.
  • Gravity: Vertical positions or side lying on bed to open the pelvis. “Towel pull” squat for 3-6 contractions, hot washcloth on perineum for privacy, cold wet washcloth on anus to prevent or soothe hemorrhoids.
  • Movement: Rock forward and back while kneeling and leaning over a ball or raised head of the bed. Lunge if baby is asynclitic.

 

Bibiography

Labor Progress Handbook by Penny Simkin and Ruth Ancheta

Active Birth by Janet Balaskas

Comfort Measures with the Rebozo (video) by Guadalupe Trueba

Hands of Love (video) by Carol Phillips, DC

Web article with lots of blog entries describing and showing photos of maternal movement in labor at the Lamaze blog,  http://www.scienceandsensibility.org/?p=736

A blog with maternal positions for labor Birth Faith