birth center, birth team, Cervical Checks, cervical dilation, Failure to Progress, Fear, First Baby, Home Birth, hospital birth, Labor, Long Labor, Midwife, Midwife's Assistant, OB, Patient Safety, Pelvic floor, start-and-stop contractions, Vaginal Exam

The Beautiful and Mysterious Resting Phase

“OHMYGODIWANTTOPUUUUUUUSH!!!!”

This was Zoey’s second baby and second planned home birth. She was 37 years old, had an uncomplicated pregnancy, and had been in fairly meandering labor – contractions maybe 4-5 minutes apart, at their most frequent, since 2 AM. Her last cervical check, at 4 AM, had her at 4 cm. Her sudden announcement of a strong pushing urge came at 8AM, the height of rush hour traffic, naturally.

I thought briefly of offering her another cervical check, but with second-timers, I always feel like cervical dilation is even less predictive for time-of-birth. She had clearly announced feeling pushy, and had reported rectal pressure for the previous hour. Plus, her water was broken. Why mess with it?

“Oh! Fantastic! I’ll be right there, I have to call the assistant!” There wasn’t a moment to lose; the assistant lived across town and second-time birthers are famous for fast pushing phases.

Having locked down the birth assistant, I went back to the bedroom and… nothing. Ten minutes went by, twelve…did I jump the gun? An hour later the assistant arrived, with Zoey’s contractions having spaced out to a reliable 8-12 minutes apart. Pushing urge: GONE. I felt sort of silly.

“Maybe I called you too early. Sorry. I hope you didn’t break any traffic laws.”

“That’s ok!” The assist said with a smile. “She’s probably just in a resting phase.”

Resting phases are well known in home birth circles and yet somehow they terrified the hospital care providers I encountered in my doula days. I admit it’s counterintuitive when labor is trucking along, you think you’ll have a baby born in the next few hours and then labor just…stops.

Anne Frye, author of several gigantic, well-researched and just a little bit witchy textbooks about home birth midwifery, states in Holistic Midwifery, Volume II:

One of the most important contributions midwifery care has made to the understanding of labor has been the recognition that after full dilation is reached there is often a period of uterine quietude that occurs prior to the onset of active pushing.

The theory behind resting phases has to do with the physiology of the uterus and the cervix. Here’s how it works:

Generally speaking, labor is powered by a feedback cycle. The presenting part (usually the head, but it could be a bottom) is applied to the cervix and slowly stretches the cervix open. There are receptors in the cervix that register this stretching sensation and stimulate hormones that produce contractions. As the uterus contracts, it moves the presenting part further down, continuing to stretch the cervix, and the cycle continues.

Once the cervix is “complete”* – which is often noted as 10 cm, though that number is mostly mythical – there is no cervix left to stretch and the baby is very low. Thus, the uterus isn’t stimulated to contract by the same feedback process, and there will be some slack in the upper part of the uterus, behind the baby. The uterus now has to do some work to “catch up” with the baby.

The top of the uterus – the fundus – slowly thickens behind the baby and then continues to move the baby down with contractions that may be much more spaced out than before. When the presenting part is low enough, the urge to push will spontaneously arise, and labor will usually speed up again.

Resting phases can last a few minutes to, in my experience, about 4 hours. I can’t speak for anyone else, but I definitely have a shift in my own energy and mood during resting phases – there’s a little electricity at the back of my neck. I feel antsy, like I should be doing something.

Self-awareness and patience are key, as well as educating the parents about the normalcy and benefits of resting phases. Many parents, especially partners, will express fear that the resting phase means there is a complication, or that labor is “going backwards.” Hospital care providers I have worked with have historically offered Pitocin augmentation or to break the water in order to to speed labor up when a resting phase arises. Rarely are these concerns or interventions necessary. We can “rest and be thankful,” to quote author and birth activist Sheila Kitzinger.

Resting phases will enable a birthing person to:

  • Nourish and hydrate
  • Take a cat-nap
  • Perhaps get a break from any previous labor-related vomiting
  • Baby also gets a rest! Don’t forget that each contraction is a normal, hypoxic event for baby. A resting phase gives baby a chance to regroup.
  • A resting phase may be a nice time to do restful positions to help a baby get into the best position possible in the pelvis.
  • Partners get a break. I always encourage both parents to snuggle up in bed, and I adjourn to another room. If contractions have spaced out enough and baby has sounded good thus far, I might allow a little more time to go by between heart tone auscultations so that monitoring is less disruptive.
  • If I am working with a very anxious laboring person, a resting phase is a good time for questions to be answered and to talk through any challenges or anxieties.
  • A resting phase will allow the laboring person more time to integrate how far they have come in this labor and what the next phase will bring.
  • This is a great time for the birth team to make sure all equipment/meds are set up to our liking and to rest and nourish, ourselves.

About 1.5 hours after the arrival of the assistant, Zoey’s contractions picked back up to 3 minutes apart and her pushing urge spontaneously reappeared. 45 minutes later, her 8 lb 9 oz baby girl was born, with Zoey in a hands-and-knees position, over a first degree laceration that we did not suture.

*This process can also happen before the cervix is completely dilated. The urge to push has less to do with cervical dilation and more to do with the descent and position of the baby, hormones, and the sensitivity of the stretch receptors of the cervix.

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