In doing some research for my book, just recently I read an article entitled, “What is women’s experience of being at home in early labour?” This article cites that there were four main reasons women came into the hospital “too soon” despite knowing that there was no need to arrive before active labor was well established: Reassurance, Uncertainty, Pressure from Others, and Permission. This article made me want to write a blog post (which has now ended up being a 3-part series!) about re-thinking early labor. I’m interested in how we, as Childbirth Educators, can do a better job at preparing our couples for the realities of early labor. Later in the series I offer concrete things to consider in helping women and their partners pass the time of early labor and stay at home longer. This is one of the most effective ways to avoid unnecessary interventions, medications and Cesarean Birth.
First, a definition: Early labor, also known as the “latent phase” is so named because you’re not yet in active labor. This phase is most commonly the longest part of a woman’s labor experience and can easily take up 2/3 of the entire process over all. For over 60 years, we used Friedman’s Curve to describe early labor as moving from 0 cm dilation to 4 cm dilation. In very recent history, this curve has been under increased scrutiny and it’s now more widely believed that active labor does not really begin until a woman has reached 6 cm dilation.
This distinction between onset of active labor changing from 4 cm to 6 cm dilation is important. What this small shift in definition implies for today’s providers is that they should be willing to wait awhile before making the proclamation that a laboring woman who is taking longer to dilate has “failure to progress.” Hopefully this will translate to a more “wait and see” approach rather than moving too quickly to medications, interventions or surgery for the delivery of her baby.
But the implications for today’s laboring Mommas is also significant because this means that she will likely be working longer and harder at home in the early phase of labor before coming into the hospital.
As a Childbirth Educator, I have the specific challenge of encouraging the students in my classes to stay at home for potentially much longer periods of time when they (or their partners) might have great anxiety about doing this. How do we help a woman increase her chances of avoiding unnecessary interventions, medication and Cesarean Birth, but also address the level of anxiety that she (or her partner) might feel about continuing to cope through early labor at home?
First, reassuring every woman that her body is amazing and completely capable of giving birth to her baby should be a top priority. Too many of today’s pregnant women lack that celebration of their bodies and instead of feeling beautiful, strong and capable – they often feel insecure, disconnected and unsure of themselves. First time Mommas especially tend to feel like everything that happens to their bodies while pregnant is so foreign and strange that it’s hard to believe that any of it is normal. Any amount of information we can provide a woman about her body that reinforces how she is exquisitely made for the process of giving birth should be addressed early on in our classes.
The normal progression of labor should be presented in a way that boosts a woman’s confidence. Great care should be taken to explain what early labor really looks, sounds and feels like for the majority of women so they can begin to release the cultural construct that says labor is unbearable from start to finish. Women need help realizing that the depiction of birth they see repeated over and over again in movies and TV shows is done purely for dramatic or comedic effect. In reality, most first time Mommas can expect a slow and steady marathon pace of labor rather than a mad dash to the finish line. This information can help them realize that when early labor begins (after their initial moment of freak-out) they should settle in for what will most likely be a long wait until it’s time to come to the hospital or birth center.
Okay – so, maybe they’ve bought into this idea of waiting until their contractions get to a pattern of 5-1-1, or even 4-1-1, before making the move toward the hospital or birth center. They’ve read the articles that tell them that their chances of having unnecessary interventions and medications go up if they come to the hospital too soon. They don’t want to come in only to be sent home again. They get it.
But how do they manage to stay at home when labor drags on and on? If their water hasn’t broken yet (and for the majority of women this will be the case. Their water won’t break until they’re in active labor or actually pushing their baby out), how will a woman know definitively that she’s in labor and then feel like she has what she needs to pass the time of early labor at home? How can she do this in a way that progresses her labor and doesn’t make her crazy with anxiety?
That’s where Childbirth Educators come in – we have to convince Mommas, and their partners, that it makes sense for them to stay at home for all, or at least, the majority of their early phase of labor. But – we have to provide them with real and concrete ways to do this.
In my next post, I will share with you the first five ways we can do that from my “Top 10 Things to Consider in Early Labor”.