In my last two posts, I discussed how laboring women and their partners are being encouraged to stay at home and away from the hospital for most, if not all, of their early labor. But the definition of early labor has changed. It is now believed that a woman is still in early labor until she reaches about 6 cm dilation. This means most women will be at home working for longer periods of time through the early phase of labor. It’s not enough to encourage women to stay home. We also need to provide some ideas about how to stay home and continue to cope with contractions of early labor without anxiety settling in. This is the final post in my three-part series, “Top 10 Things to Consider in Early Labor.” Here are the last 5 ideas from that list.
6) Clear your day. If either of you had been planning on being at work the morning that labor begins, call in and let one trusted person know that you might be in early labor. Ask them please to not tell the entire office your news as it might prove to be super early labor, or maybe just a good bout of practice labor – and you don’t want to have to field a ton of phone calls, emails or texts from your excited co-workers.
7) Plan a date. This is the one thing that I get the most heat for encouraging people to consider, but I swear it helps you get your mind in the right place for the start of your labor experience. Most first-time Mommas have loads of time between when labor begins and when they reach active labor. And if you have something to look forward to as labor begins, you’re more likely to enter into early labor with a more positive attitude. This can definitely impact how well you’re able to handle your early labor. This labor day date doesn’t have to be anything special, but there should be some actual direction to it, a potential theme. I’m not sure it’s enough to say, “We’re going to watch a bunch of movies” or “We’re going to play board games.” Which movies do you want to watch? (Make sure they’re pretty emotionally charged – those that are can help boost your oxytocin levels by up to 47%!) Get out the board games and lay down a challenge. Card games that can go on forever are really great because they can be left hanging if your labor should pick up speed. If the weather is nice, plan a picnic lunch. If it’s not, picnic on your living room floor. Go for a walk – just make sure that you pass by your car every 1/4 mile or so in case labor changes dramatically. You don’t want to have to walk 5 miles back to your car with really challenging contractions if labor moves from early into the active phase while you’re out and about. This date should be focused on distraction and enjoyment. This is the last time you’ll be able to go out as a twosome without the baby or without paying for a babysitter. Don’t waste this opportunity.
8) Consider hiring a doula. (This actually could have been #1 on my list of things to consider if I were rating them, but I wrote this list more chronologically in terms of what to consider as labor progresses.) Having a doula who is yours and yours alone ready to take your phone calls or texts in early labor or even stop by your house to check in with you can really make a difference in your continued ability to progress in early labor at home and away from the hospital. A doula’s expertise about what labor looks, sounds and feels like for most women will mean that she can normalize what you’re experiencing. She can also suggest comfort measures that can help you continue to cope and remain comfortable in your home for longer. When I’ve asked new parents from my classes what advice they would offer to expectant couples, they usually say, “Tell them to stay at home for as long as possible!” Having a doula to check in with might allow you to do just that. And doulas only get better as labor progresses! If a doula is not possible for any reason, who else can you check in with during this long and sometimes frustrating early phase of labor? What does your provider have to say about contacting them in early labor? If you contact the hospital looking for guidance they will often either refer you back to your individual provider – or tell you to come in to be checked. This defeats the entire purpose of trying to stay home in early labor. An unnecessary trip into the hospital is a real bummer and can start you down a path you might be trying to avoid. Do you have a friend or family member that’s given birth before that you might be able to touch base with for reassurance that you’re moving in the right direction even if it feels long and slow-going? Enlist their help to be that touchstone for either you or your partner during this early part of labor. Remember, reassurance is key during this early phase.
9) Use those comfort and coping techniques that you learned about in an evidence-based childbirth preparation class. Initially, you might find that focused and intentional breathing are all that you need to get through the peaks of contractions. But don’t forget to think about using different positions, sitting on the birth ball, getting into the shower, vocalizing, looking at a focal point, enjoying lots of massages, using rhythmic movements and getting plenty of encouragement from your birth team members as ways to help you continue to move through your early phase of labor and into the more active phase. Understand that you will need to do some of the hard work of labor before any medication will be a realistic option for you. Pay attention to this section during your classes, even if you are “planning on the epidural.” You’ll need to use some of these techniques at the end of early labor while you’re still at home, for sure while you’re making your way into the hospital and definitely when you first arrive as you move into active labor.
10) Wait until your contraction pattern gets to at least 5-1-1, maybe even 4-1-1, before you head into the hospital. What does this mean? You want to wait until you have a labor pattern where contractions are 5 or 4 minutes apart when measured from the beginning of one contraction to the beginning of the next contraction, each individual contraction is 1 minute long, and this has been happening for at least 1 hour. In addition to this, your contractions should be strong enough that during the peak of each one, you are unable to walk, talk or smile. You are all business and your full concentration is on getting through each contraction. When this is the case, you’ll be working hard and that means that you’re moving through early labor and into active labor. This is the perfect time to come to the hospital or birthing center as any distractions there will have less power to negatively impact your labor progress.
How long will all of this take – this early labor? For most women, it will be the bulk of their labor overall. If you had a 24 hour labor, you could expect maybe16 hours of it to be in early labor! For the majority of women, they should expect to be laboring at home for about 2/3 of their overall labor. (This is, of course, based on averages of labor and your situation would be contingent on so many different things that makes this just an example. You could be at home shorter or longer than this and all would be in the realm of “normal.”)
I feel very strongly that it’s not enough to encourage women to “stay at home as long as possible” without providing some real tools about how to do just that. We have been fed a cultural construct about birth that makes it seem impossible that we could be in early labor walking around the neighborhood, going out for a bite to eat – passing the time of these short and do-able contractions without it being a huge, dramatic experience. Women need to have more confidence in their bodies and their ability to judge for themselves whether or not they are in labor. Too often they feel they need to have someone else tell them they’re in early labor for it to be “official.”
Coming to the hospital and being told to go home can be devastating for a woman, not just because it’s an unnecessary and uncomfortable car ride, but because it makes her second guess her ability to make the call and determine what “real labor” looks like. Providing women with the “Top 10 Things To Consider In Early Labor” is my contribution to helping women feel like they can cope with early labor and feel prepared to stay home as long as possible to progress in their labor and reduce their risk for unnecessary interventions, medications and Cesarean Birth.
I’ve never had a woman come through my class saying, “I can’t wait for all those interventions – bring ‘em on!” Most are wanting to avoid all of them if possible. Waiting through the early phase of labor before coming to the hospital or birthing center is an great way to start their individual birth story.
How can we, as Childbirth Educators and new parents get the word out about rethinking early labor? What other practical ideas do you think should be added to my “Top 10 Things to Consider in Early Labor?” I’d love to offer as many tips as possible for my expectant families, please feel free to share your own ideas in the comments.