How to Handle a Long Labor
(So You Can Have a Beautiful Birthing)
How many times have you heard a story about “being in labor for days” where everyone in the room cringed. How many times have you heard of a mom having a cesarean for “failure to progress?” Long labor is something birthing women and their care providers have been taught to fear – but why?
What does “long labor” even mean? Can we measure it accurately? Does it have any evidence to support it?
And what do you do if you find yourself in the middle of a long birthing time?
Why all the Fuss?
Lets start with the question “what is a long labor?” Most hospitals measure labor based on the research of Dr Friedman in the 1950's. He created what's called the “Friedman's Curve” and it specifies a curve that goes from the beginning of labor to baby in about 12 hours1. His curve was expanded upon by Phillpott and Castle in the 1970's, which resulted in what's called the “partogram graph.”2
It's still based on a 12 hour labor, and includes guidelines on when to augment labor (bring in Pitocin or Syntocinon), be on alert, etc.
One of these two “tools” is used to monitor women's labors almost universally. It means that laboring above 12 hours is usually cause for alarm (and various clinical labels) – not to mention the perception that a woman is somehow suffering because she's having a “long” or “slow” or “inefficient labor.” Even the WHO recommends that labor be “managed” using a partograph that places strict limits on how long a woman is “allowed” for her birthing time (8 hours of labor before an “alert” is issued, followed by cesarean at 12 hours)3.
The problem is numerous studies have proven the original “12 hour window” Friedman determined is completely inaccurate.4
The truth? Woman are not machines. They're not designed to move along mechanically or even efficiently (that's a technology term, not a birthing term). “In contrast, research has found that cervical dilation patterns vary widely between individual women, and the average length of labour is much longer than in Friedman’s findings.” – Rachel Reed 4
Determining what's “normal” in labor is actually close to impossible. That's because “normal” has no definition. It's completely relative – just like it was back in junior high when the cool kids were “normal” and you were “weird.” It's a pointless classification based, essentially, on opinion.
Women's bodies open at different speeds. They actually open in different ways. And the baby is not a passive little watermelon during the birth process – he or she is also moving, turning, and working (check out my podcast on baby's experience of childbirth – opens in a new tab for your convenience).
Some women have a lot of contractions, rushes, birthing waves – whatever you want to call them – with no discernible “progress.” Then, suddenly, her body is spontaneously pushing her baby into her hands. I know this happens because I was one of those women. And first time mamas often have slower, “start and stop” progress.
And there are exceptions to the exceptions, every day. Every mother and baby is unique, and birthing is a journey that goes far beyond opening up and pushing/pulling out. It's biological, hormonal, mental, emotional, even spiritual. Men have traditionally created a rite of passage for boys to become men. Nature designed the rite where women become mothers.
We can debate all day if their should be limits on labor – and if the sacred cow of “stages of labor and their respective lengths” is even remotely applicable to conscious, well-nourished, well-prepared birthing women. But, we'll move on to some things that could influence a birthing time to be longer than it otherwise may be – and what you can do about them.
Environment May Play a Role
It is true that environment can have a huge impact on birthing. You know that animal mothers seek solitude, quiet, and even darkness for birthing. It's actually held sacred for animal mothers – if your toddler or eager preschoolers stumble upon your cat's labor “nest” you take pains to redirect your little one and give her the peace and quiet she not only deserves, but she needs.
Your body also needs quiet, privacy, and even low-lighting for birthing. Birthing is an incredible orchestra of hormones (my podcast on the hormones of birthing talks about this – opens in a new tab). Chatty observers, beeping machines, bright lights, cool air – even moving from one environment to another (home to hospital, for instance) can interrupt the complex, behind-the-scenes work of birthing.
What You Can Do
Understand that environment can and does have a powerful impact on your birth. Take steps to create an environment where you'll feel comfortable. You may take this for granted at home, but you shouldn't. Be sure that your care provider is on the same page as you. Avoid inviting a lot of observers. Make arrangements for older children (they can be included but should have a respectful – even reverent – care person dedicated to them). Consider the lighting and what you want in your environment. Considerations will be similar for a birth center, but remember to give yourself time to feel secure and safe after the transition from home to birth center.
You'll need to be really proactive if you plan on birthing in a hospital setting. Policies and procedures can make undisturbed birthing truly challenging. The very first step to take is to completely prepare for birthing – both with knowledge and skills. That gives you the advantage of being able to adapt and work with hospital policies.
But don't stop there – advocate for yourself and your baby. Ask for a nurse that enjoys working with families having natural births. Dim the lighting. Request intermittent fetal monitoring. Continuous monitoring puts you at major disadvantages and has no scientific evidence to back up its use.5 Intermittent monitoring means you can be mobile and your nurse or midwife checks the baby's heart tones from time to time which is proven to be effective and lacks the high false-positives of continuous monitoring.
Get up, move, and work with your baby's efforts to be born in an environment where you feel safe and supported.
Emotions May Play a Role
As I mentioned above, birth is not a purely mechanical, or even physical event. Many women need to process things during labor – even if they've given birth before.
You've probably already heard that fear can stall labor, and that's very true. Fear stops labor for you just as it does for an animal mother, or a women birthing out in the wild. Your body doesn't discriminate between fear of a lion prowling and any fears associated with modern birth. They all halt labor so you can get somewhere “safe.” You can work to overcome these fears during pregnancy – and again, make conscious choices about your birthing environment.
There are other anxieties that may surface during labor. Some may be related to the baby, to your ability to be a good mama, or even relationship issues (with a spouse, parent, etc.). All of these things can slow down birthing while you process them.
What You Can Do
A lot of the work of birthing can be done during pregnancy – especially the emotional work. Take the time to consider your fears or anxiety about birth and work through those. This is especially important for first time mamas and mamas planning a VBAC. But it's valid for every mama, in every pregnancy. As midwife and Russian birth pioneer Elena Tonetti-Vladimirova says “when you do the work in pregnancy, there is nothing left to do but give birth.”
But even if you're completely prepared during pregnancy and consider everything you can think of, there are times that “something” – whatever that may be – comes up during labor. It could be something unresolved from another birth or relationship, or some worry you have about the future. Whatever it is, honor that and take the time to work through it.
Then honor birth and your baby's journey – give time for that to get moving again. And recognize that emotional issues often require patience. As long as baby and mama are doing well, it's safe to continue to wait on your birthing to move at the right pace for the two of you.
Baby Positioning May Play a Role
While “failure to progress” due to a baby being “too big” is really quite rare, it is true that a baby that starts labor in certain positions can take longer to birth.
Posterior positions, where baby's back is to your back and baby is looking towards the front, generally take longer to birth. Your baby needs to rotate more within the womb to begin decent down the birth canal. Sometimes your baby may be angled so his or her head isn't contacting the cervix fully, or is moving toward the birth canal at an angle. Baby often needs to move and rotate to negotiate into a different position (or just come down more slowly and “sunny side up”!).
We can't see these things happening during birthing. They're unseen and it may seem like “nothing is happening” – when in reality baby is working really hard. Listening to your body, getting upright, and getting moving often help you help your baby.
What You Can Do
You can work on baby positioning prior to the beginning of your birthing time. Take a look at my strategies for good baby positioning as you get close to your due date (babies still move a lot – right up until the days before labor, so don't stress too much!).
It doesn't hurt to implement good baby positioning habits into your life – but remember babies can and do turn during labor. It's important to go into your birthing time relaxed and rested, so don't let baby positioning cause you to fear relaxing positions or cause a lot of stress.
When You Just Need to Keep Going
Sometimes birthing takes time. Your body needs to open at its pace. Your uterus needs to pull back and thicken to create a effective muscle force to push baby out. You need time to emotionally integrate everything going on. Baby needs time to turn and move down through you bones. If you're a first time mama this is the first time your pelvis has ever opened for a baby to come through. And your body and your baby can do this work – dance this dance together. But it might be a slow dance rather than a rapid sprint 😉
VBAC mamas should also be prepared for labor and birth as a first time mama, especially if you haven't had a previous vaginal birth.
Of course, there may be times when a long labor isn't normal – you may strongly feel something isn't right, or you or baby are showing signs of distress. In that case, you should get help. But most of the time you, your body, your baby just need time to move through the awesome work that is birth.
Regardless of the reason your baby and your body need “a little more time” remember, you will give birth to your baby. Your baby is coming.
Practical support is also important. Maryn and Margo share a lot of great ideas in their webinar on long labors (opens in a new tab for you).
Labor is intense and it's a lot of hard work. Eat frequently, even if you don't feel like eating. Mamas who have quick labors may not need anything, but most mamas do need a little something – or more. Easy-to-eat foods like scrambled eggs, toast with peanut butter and/or honey, and smoothies are good ideas. They give a quick pick-me-up and protein to help keep energy going. Drink regularly too. A helper should offer (insist) on food and drink every hour or so. Don't forget to go to the bathroom, too – a full bladder can hold things up and cause extra bleeding after your baby arrives.
Food, drink, and bathroom reminders are a great way for your support person to get involved (have a list of things they can easily offer you). But that's not where a support person's support should stop! Be sure, first of all, that your support person(s) understand that labor can and does sometimes take awhile. Their fear become infectious, so you want to clear their fears before birthing begins, too.
Let them know they can keep their own strength and energy up (it may be good to have someone step in while they rest during a long labor) – and most of all that they are important for helping you keep up energy and confidence that baby is coming.
Know tools to work with baby – this comes back to preparing during pregnancy. Walking, stairs, rebozo scarves, birth balls, and a variety of techniques can help you work with your baby and his or her position. Knowing some good positions for resting can help you restore energy over the long haul.
It can be helpful to make a plan too, and sometimes mamas in a long birthing want to know progress – generally vaginal exams aren't helpful, but if your birthing time is long and knowing your progress helps you, you can ask for one. Use that information and the other techniques and strategies you've discovered before birthing to help you hang in there and work with your baby until he or she is born.
Throughout all of this you can monitor yourself, and helpers (and you) can monitor baby's well-being. As long as both mama and baby are doing well, it's generally safe to keep working with your baby, knowing that your little one will come out – and what a sweet moment that will be!
Any mama that gives her body and her baby time, and works with her baby is awesome… you are strong, mama! Long or short, you can do it 🙂
1. Friedman EA 1955, Primigravid labor: a graphicostatistical analysis, Obstetrics and Gynecology, vol. 6, no. 6, pp.567-89.
2. Philpott RH & Castle WM 1972, ‘Cervicographs in the management of labour in primigravidae. II. The action line and treatment of abnormal labour’, Journal of Obstetrics and Gynaecology of the British Commonwealth, vol. 79, pp. 592-8
3. http://helid.digicollection.org/en/d/Jwho34e/6.11.html (accessed 11/4/14)
4. http://midwifethinking.com/2011/09/14/the-assessment-of-progress/ (accessed 11/4/14) – Rachel Reed gives extensive references proving the partograph inaccurate
5. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(87)91266-9/abstract (one of many such studies)
Photo by Noah35