Thursday, September 25, 2014

Why won't this labor start properly?

This post discusses onset of labor.

A woman is commonly considered in labor when her cervix is progressively opening and continuing to open. Stages of labor are the first stage of cervical dilation, the second stage of "pushing" or until the actual birth of the baby, and third stage which begins after the baby is out and until the placenta is out. A fourth stage of labor is described as the following period of newborn and mother's adjustment from birth to physical stability.

Early labor from 0 or 1 cm to 3-4 cm.
Early labor is a time we expect baby to be engaged. In an experienced mother, engagement may not occur before latent labor in an on and off labor pattern, or in early labor, where dilation is gradually moving to 3-4 centimeters. A minority of women are open to 3 or more centimeters when labor begins to open their cervix further.

In first births, for first time mothers and for many VBAC (vaginal birth after cesarean) we expect baby to engage before labor starts. When a first baby isn't engaged until labor begins the rate of cesarean is high. (Oboro; Siddiqui; ROSHANFEKR) Fortunately, we can let babies engage in labor with the help of labor contractions in certain maternal positions described at www.SpinningBabies.com.

This baby is not engaged although the nurse can feel the back of baby's head.  The forehead overlaps the pubic bone.  Overlapping the pelvic brim may keep labor from starting smoothly, or, oddly enough, the woman can get to 10 cm and pushing but the baby remains high at -3 station. The overlap can only be felt when a woman lays on her back. 

The slow labor start up.
Women may have contractions that keep them awake. Yet when the cervix isn't dilating they aren't considered to be in labor. Doctors and midwives often tell them to go home to bed and come back when contractions are longer, stronger and closer together.

The stop and start labor.
Other women may feel their contractions come strongly but then they taper off and stop. They can get very strong, but seem to back off. Later the contractions may start up again only to stop again. The cervix isn't changing or isn't changing in any encouraging amount.

Strong contractions like transition, but the cervix is 2 cm dilated.
Once in a while a woman has many symptoms of strong active labor. She may feel a bit nauseous, shaky and have hot and cold flashes. Sometimes she feels like pushing. Rushing to the hospital, she and her loved ones and doula may expect to find out that the baby is coming quickly. Imagine the frustration when the nurse checks and finds out that the baby is still high in the pelvis or even above the pelvis. The cervix is hardly opened and the os or opening of the womb is still tilted far back.

If labor doesn't start smoothly, determine through an exam or your own exam if baby is engaged well or not. Engagement is the first step to labor progress.

The help to engage is within the mother's body. Balancing the body (fascia, ligaments, muscles and joints) help soften those anatomical features that may be tight or shortened, spasming or asymmetrical. Simply put we release what is tight.  The psoas muscle pair are key players and walking is a way to support their length and suppleness.

She does an abdominal lift while flattening her lower back.

Dad helps with an abdominal lift in early labor to engage baby and let labor progress.

In labor, the abdominal lift and tuck through ten contractions often helps baby engage. See more on this great technique devised by a mother, Janie King, in her book Back Labor No More.

Only if this technique doesn't work, try Walcher's Open-the-Brim position. For details on Walchers and more on Engagement in Labor see www.SpinningBabies.com

3 comments:

Denise Hynd said...

Please consider what all this engagement of the woman's senses, particularly her thinking brain around concern that her labour is not starting optimally, correctly etc (and hence she is probably producing adrenaline) is doing to the very vital flow of oxytocin and to what is being sought?

missymoo22 said...

Trying to sign up to the mailing list, but it requires a state to be added (I don't live in the US), and it doesn't accept entering one randomly..how can I get around that? thank you!

Spinning Babies Lady said...

MissyMoo22, please email me your email address and we'll hand enter you with your permission. Thanks for notifying us! gail@SpinningBabies.com

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