birth center, birth team, Cervical Checks, cervical dilation, Co-Dependency, Epidural, Failure to Progress, Fear, First Baby, Home Birth, hospital birth, Labor, Long Labor, Midwife, Midwife's Assistant, optimal fetal positioning, Sexual Abuse, Trauma, trauma informed care, Vaginal Exam

Long Labors, Part 3: Psychosocial Strategies

Long Labors, Part 3: Psychosocial Strategies, is a follow-up and final installment to Long Labors, Parts I and 2.

When a client is having a very long labor, I tend to assume mechanical challenges are the direct cause and problem-solve on that basis, first.

Many emotional and spiritual forces can arise during labor as well – but focusing exclusively on these can run the risk of blaming a person for their long labor, or making them feel as though there is something fundamentally wrong with their very self. Even if I suspect the “problem” is more psychological than physical, the laboring person still has to work through the challenge in their own time. Letting them know I’m available for supporting that is about the best I can offer in the moment. The following issues and recommended strategies may be more usefully addressed before labor.

History of abuse/trauma. No one expects you to heal all your wounds before the baby comes. But simply acknowledging abuse – particularly sexual abuse  –  and understanding how it can influence your birth will go a long way.

If you go by the theory that trauma is stored cellularly, then your body isn’t going to know the difference between a fetal skull exiting the vagina and an unwanted object entering the vagina. The sensations of birth can trigger traumas we haven’t felt since we were abused, often as children.

Naturally, you might seek out somatic therapy or talk therapy directly related to trauma, before baby comes, but it’s not a requirement. In fact, you may feel that pregnancy is not the time to dive into major healing.

However you decide to handle it, consider telling your care provider, your partner, and your doula if you know you have a history of abuse. They can support you, help you stay present, and remind you that you are no longer a child who is a victim, but an adult now having their own child.

All care providers should be offering trauma-informed care by default, but if your doctor or midwife knows you have a history of abuse, they may be more likely to slow down and ask for consent.

Carefully choose your birth team. A rule of thumb for planning your birth: Keep the observers to a minimum. Laboring people who come from very large families, who feel safest and most at ease with tons of people around the house, do fine with lots of people at their birth. Most of us, however, will want the fewest amount of people who can provide the maximum amount of support.

Consider the space where you will be birthing. For years I worked at a very small birth center where there was no place for extra family members to go. If labor ran long, family members became uncomfortable. Often the laboring person had no privacy. I confess that as a midwife I felt like a party hostess and was often approached for resources such as bathrooms, food, water, and places to sleep, when these resources were not my job to provide.

Home birth is a little different – while there may be limited square footage in a particular living space, as a midwife I am on the client’s turf and so are the family members. It changes the dynamic and I am better able to focus on the laboring person rather than the guests.

A typical birth team in my practice usually includes: The laboring person, their partner, the midwife, a midwife’s assist, and either one supportive friend or family member, or a doula. That’s four people besides the laboring person, already, and everyone has an important job to do. It adds up!

Other questions to ask about your birth team:

  • Do the people you’ve invited support you unconditionally? Do they have biases, fears, and judgments about how how you are choosing to birth? Probably! We all do! Do they have the emotional maturity to put those biases aside and show up for you without judgment or control? Sometimes not!
  • Will these people be butthurt if you change your mind and ask them to leave? Will you be taking accountability for their feelings and egos while you are also doing the work of labor?
  • Does each team member have real job to do? Or will they be sitting around, growing increasingly bored, tired, and impatient? It’s astounding how many people will be cranky about a baby taking “too long” when they are just bored and desperately need a nap and a sandwich.
  • When inviting your own parents , consider that your parents’ experience of watching their baby have a baby may be very stressful for them and that you may take on that stress.
  • Are you inviting a person to your birth in order to affect their healing? Your sister or friend may have had a traumatic birth but it is not your job to heal them by giving birth in front of them.
  • Having the baby’s older siblings attend the birth can be either wonderful or scary for the child, depending on the personality of the child. Be sure that the sibling has a devoted care person who is not you or your partner, so that you both can focus on giving birth, not parenting your older child. Allow the child to self-regulate and to come and go freely from the room with the supervision of their care person. The care person must understand that their job is to take care of your older child, not to be a spectator at your birth.

Feeling pressure from a person who feels entitled to attend your birth is never ok. 12-Step programs and therapies that focus on co-dependency can help you sort through conflicting feelings about who to invite to your birth. Becoming a parent may be a good time to learn how to set healthy boundaries, but this is often more difficult than it sounds.

We all like to believe that we are independent thinkers and achievers and that we don’t care what other people think. But when you are going through a big life change, it can be hurtful and scary not to have the full support of your clan. Remember that you are about to become this baby’s clan. You do not owe anyone in your life a front row seat to your experience in order to receive support.

Carefully choose your care provider and environment. Our bodies work better when our stress levels are lower. Babies cope better with labor when our stress levels are lower. This means that the feeling of safety actually contributes to safety!

Insurance policies, dollars, medical risk factors and physical location often limit our birthing choices. Please go out of your way to find the best care provider and birth environment your circumstances allow. Consider driving a few more minutes to a hospital that has a lower Cesarean rate or better birth outcomes. Consider out-of-hospital birth if you are an appropriate candidate.

When I worked as a doula, I frequently interviewed with prospective clients who would say, “I really don’t like my doctor. He totally doesn’t share my goals or preferences. But it’s too late to change providers, now!” They would go on to say that this is why they were hiring a doula. Let’s be clear – a great doula can work miracles through support and presence, but a doula is not your body guard and cannot get in between you and your care provider. If you don’t feel comfortable with your care provider, take the trouble and switch. The problems that are coming up in prenatal care will only be amplified in labor.

This goes for doulas, midwives and any support people who are planned at your birth. If something is nagging at you, address it, or switch.

Stay home from the hospital or birth center as long as you feel safe doing so. If you are a first-time mom and considered low-risk, your care provider may encourage you to “stay home as long as possible.” This is because a first labor often lasts longer than we anticipate. A kind of clock starts when you are admitted to your birthing place, which doesn’t exactly help you relax into labor. Care providers can get impatient, too, and suggest interventions that may . not be necessary.

You are going to feel a lot of strong new sensations in early labor that don’t mean a baby is coming out of you right this second. If you are nervous about staying home while experiencing labor for the first time, consider hiring a doula.

Some people are terribly afraid of going to the hospital or birth center, only to be turned away because they’re not active, yet. I encourage you to re-frame it: You are being sent home because your baby is healthy and you are healthy. Your care providers trust that your body will open up on its own time.

When my home birth clients have very long labors, I will often do a “labor check-in.” This involves me going to the house to check baby’s heartbeat, the birthing parent’s vitals, and just hanging out for a little while, giving labor suggestions. I make it very clear that I will likely not be staying. I will offer a cervical check, which may or may not be accepted based on individual preferences and circumstances. Occasionally I will offer an IV if the laboring person hasn’t been able to hydrate properly.

Sometimes, very pleasant surprises have happened, in which I arrive expecting very little dilation, only to find that a baby is much closer than we thought. In such a case, I stay. But if labor is still early, once I ascertain that all is well, I will leave and await further changes by phone.

One thing to keep in mind: If you are experiencing absolutely insufferable pain and your care provider wants to keep you home, you may always advocate for pain meds. It is possible that your labor isn’t normal. Asking for meds or an epidural in this scenario may help you to have a better birth outcome, rather than hinder it.

Know that you will want to nest:  I try not to be a home birth evangelist! However, I could have done many things with my life and I still choose to stay up all night delivering babies in people’s living rooms because I think it works.

When mammals are in early labor, they nest.

You are a mammal, and when you are in early labor you will be driven beyond reason to settle into the place where your baby will be born.  This is utterly natural. The problem? Your planned place of birth – the hospital or the birth center – won’t admit you until you are in active labor. There could be many hours or even days between your desire to nest and your admittance into the hospital or birth center. This in itself can cause emotional distress and a perception that you should be laboring faster.

Consider giving birth in your own nest and hiring a midwife who comes to you. If that’s not appropriate, create your ideal labor nest at home in early labor. There will likely be plenty of time to settle in at the hospital, and if there isn’t, it means you’ve got a baby coming faster than anticipated, which is great news!

Figure out the fear. Fear is normal and healthy. Fear has kept you alive on the planet for this long. Be grateful to your fear.

If you let fear be the boss of you, you’ve got problems. Another mistake is to shove fear under the rug. The fear will scamper back out when you are not looking. Fear translates into fight-or-flight hormones, which won’t serve you very well in early labor.

“Irrational” fear probably has a very rational basis. It’s only irrational when you obsess over it to the exclusion of other issues that may be more deserving of your time and energy. Investigate and make friends with your fear. Get really inquisitive and specific!

Why, for example, is hemorrhage your biggest fear but shoulder dystocia has never once worried you?  Where did the hemorrhage story come from? Is it in your family history? Did it happen to your best friend? Can you imagine that now this story and fear of blood loss has already, in a sense, become your own trauma? Now I want you to ask your care provider how she handles blood loss and do some research about pro-active things you can do to prevent a hemorrhage and build your blood volume.

Ultimately, you will never completely eliminate the fear or the possibility the fear will come true, but at least you’ve done some clearing and have some tangible coping mechanisms .

Don’t even try to do the math. The studies that look at how quickly women are “expected” to dilate come up with an average dilation rate over time and over many, many study participants. That is a mathematical concept that has nothing to do with how actual cervixes dilate. In addition, cervixes tend to dilate much more slowly before 6 cm, and much more rapidly after 6 cm. So if you took 36 hours to get to 6 cm, that doesn’t mean it will take you another 24 hours to get to your pushing phase. Dealing with the uncertainty of labor is really hard; don’t make it worse by setting up mathematical standards for yourself. No one can predict the future.

Get rid of the expectations. Here are some real-life examples of unrealistic expectations I have encountered:

  • My mother had a fast labor so I’m supposed to have a fast labor
  • My sister had a fast labor so I’m supposed to have a fast labor
  • My two closest friends had really fast labors so I’m supposed to have a fast labor
  • My midwife told me that the average first-time mom is in labor for 24 hours, but I’m not average, I’m special, so I’m going to have a fast labor
  • I believe labor shouldn’t have to be painful. So if I’m feeling pain, it must mean a baby is coming out very rapidly
  • My contractions are doing what I learned in childbirth education to mean active labor, so I must be having a fast labor
  • I believe in the existence of the body-mind connection, so if I believe my labor will be fast, then it will be fast
  • Jesus wants me to have a fast labor
  • If I act like I’m in active labor, then I shall find myself magically in active labor
  • If I can just get myself admitted and established at the birth center/hospital, then I can finally relax and my baby will come out quickly
  • This sucks, I need it to go faster.

Much of what I do during long labors is try to help laboring individuals and their partners just be with what is.

This does not mean that you don’t have choices or that you must wait longer than you are comfortable waiting. Quite the opposite, accepting that your labor is not moving quickly and that there is no magic bullet may help you make choices, even ones that you hadn’t visualized yourself making.

In the very least, acknowledging that your labor is moving slowly can help you refocus your efforts on hydrating, nourishing, resting.

And it bears repeating: If you’ve done everything you can do to weather a long labor and you need a Cesarean birth to meet your baby, you’ve done nothing wrong. You may never find out why you needed more help. Be kind to yourself and make the best decisions you can under the current circumstances. No matter what happens, you, too, have given birth after a long labor.

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