If you’re birthing in a hospital and find that your labour reaches a plateau or stalls, unless you’re informed about what a stalled labour means and what you can do to help yourself, it can become a very anxious time.
Sooner or later, you will receive (increasing) pressure to accept a medical augmentation to hurry things along, for example, breaking your waters with artificial oxytocin (Pitocin or Syntocinon). This is the same drug used intravenously (in a drip) to induce labour, making it much more painful and intense. It can give you less of a rest between contractions, at a time when you’re probably already exhausted, and will greatly increase the likelihood of further medical procedures, particularly a c-section.
Emotionally, you and perhaps your partner too may start to experience negative and disempowering thoughts, which can make matters even worse. For example: ‘My body doesn’t work’, ’I’m failing/a failure’, ’I’m just one of those women who can’t birth vaginally’, or ‘All this work, all for nothing.’ This in itself can set a labour back.
In the first stage of labour (contractions phase), some women will experience a plateau and some will not – there is nothing you have done wrong either way, it’s just one of those things that happens. The good news is, there is something you can do about it.
What To Do For A Slow or Stalled Labour
Firstly, you need to understand that there are several ways a doctor or midwife will medically evaluate and label the progress of your labour. This may include any of the following:
- Dilation (10cms being a fully dilated cervix, allowing for pushing)
- Strength of contractions (feeling your abdomen/electronic monitoring)
- Time between contractions
- Length of contractions
- Behaviour being displayed by the mother
Unfortunately for the birthing mother, none of these methods are reliable or foolproof, even for the most experienced carer – meaning she may end up with unnecessary interventions or tests based on those evaluations. This is especially the case when trying to assess how many centimetres dilated a woman is, for two main reasons:
1) They can’t see your cervix – they have to guess with two fingers inserted into your vagina. I’ve seen a midwife and a doctor give quite different measurements, hours apart, which greatly upset the mother. She felt like she had gone backwards from what the midwife had told her earlier. She was tired and now discouraged, anticipating the end and was closer than what the doctor had said based on his estimate.
2) One centimetre of dilation could take 10 minutes or it could take 2 hours – yet the labour could still be progressing in a healthy way. Doing an exam is not going to speed up your labour or change your progress, but it could end up slowing labour down and make you feel miserable in the process.
So there are two perfect reasons why these sorts of exams should be avoided, unless there is a genuine medical need or if your carer suspects your baby is malpositioned. It doesn’t matter what ‘number’ you are… your baby WILL come out, no matter if you’re 2 or 10 centimetres. You wont be pregnant forever.
Labour does not follow any hard or fast rules and can respond to so many different factors and influences. However, there is evidence that a plateau in labour is very normal and healthy – instead of failure to progress, it’s very much failure to wait.
So with that in mind, let’s see what you can do.
Go for a Walk / Get Up
Getting up and moving is a great way to encourage baby’s decent, which involves lots of shifting, wriggling and turning it’s way through your pelvis and behind your pubic bone. Movement on your part, especially walking and going up and down stairs, helps that shifting and moving. It also helps to put more pressure on the cervix to assist with dilation. If you can walk through a contraction, even better, but this can be a tricky feat especially later in labour!
Change Your Environment
Some questions you (or your support people) might like to consider are:
- Is the room too bright?
- Do you feel closed in or claustrophobic being stuck in a small room and need some fresh air?
- Is there too much stimulation/chatter/annoying noise going on?
- Do you need some privacy?
- Do you feel uncomfortable and/or are there a lack of labour aids?
- Is anyone making you feel uncomfortable or is someone there who you don’t want to be?
Sometimes things going on in your environment can raise your stress or adrenaline levels which can slow down or halt labour. Adrenaline reduces the amount of oxytocin (the labour hormone) in the body – you can’t have both as it’s a response your body creates to shut down your labour until you are in a ‘safe’ place again. Imagine a set of scales – one side up, one side down. High oxytocin requires low adrenaline. High adrenaline means low oxytocin… and you don’t want that in labour. If you are able to, get some fresh air, think about what you might need and consider asking for a different midwife if you’re having trouble relaxing around the one you have been assigned.
Similar to the comments on walking, changing your position helps the baby to shift and move around to get into the right spot – help him wriggle on down! Being stationary in one position can slow things down and make things more uncomfortable for a birthing mother.
Nipple stimulation produces oxytocin and can produce some strong effects, so you can try stimulating your nipples (including your areola, as a baby would when sucking) with your fingers, massaging one at a time. An alternate option is if you are still feeding a toddler, let him attach and the sucking action will do the same thing.
Massage the first nipple for 5 minutes (when there are no contractions), then wait to see what happens before doing more. It’s a good idea to take your mind off things by getting on with your usual duties than sitting and waiting for something to happen – so try and keep busy!
Once labour is well established again, stop the stimulation.
Orgasm produces oxytocin… so tap your partner on the shoulder or DIY – because it could well help labour along, and let’s admit it, you’re not exactly going to suffer for trying!
Acupressure And Or Acupuncture
Acupressure can be learnt before labour, so you or your partner can work on acupressure points should you want to get labour moving. Alternately you can speak to an acupuncturist about the possibility of them supporting you at birth or attending your labour.
Debra Betts has put together a brilliant document on acupressure for pregnancy, labour and post birth, with solutions for all sorts of situations, from encouraging labour to vomiting and nausea in labour. You can download a copy here.
More information about this can be found in our natural ways to induce labour article.
Consider Emotional Factors
This can be an unexpected thing to consider, but childbirth can bring about a big emotional upheaval for some people, anticipated or not. Perhaps you or your partner is really wanting a boy and you’re having a girl… perhaps you’re anxious about pushing baby out or are recalling a horror story from a friend… perhaps you have had someone close to you pass away recently… perhaps you feel scared worrying about what will happen after the birth, because the baby was unplanned and you or your partner are not sure how you feel about things.
At births I have supported, I have seen occasions where parents (or others) turn up unexpectedly and unannounced, asking to wait for the mother to birth – even where it was the mothers wishes for them not to be there. This happen and it can really set back a labour, requiring time to help the woman become focused and calm again – never anger a labouring woman!!! So perhaps you are worried this situation may occur and feel anxious for this reason. At the end of the day, there are just so many things that can mess with the process of labour when you mess with the mother’s right to privacy and safety.
Exploring any psychological reasons that may come up during your labour can be a huge help, ideally if you are aware of any before you give birth. It is common for women giving birth who have lost their own mothers tend to go through some strong emotions. In any case, it would be a good idea to seek counselling to help deal with how you feel to prevent events playing out in labour. If something does happen during labour, then hopefully you can find a midwife (or your doula or partner) you trust to let them know what’s going on.
Wait it out! Yes!
The following study was published in October of 2002:
Zhang J et al. Reassessing the labor curve in nulliparous women
Am J Obstet Gynecol 2002 Oct; 187:824-8
It states: “Dilation in the active phase was much slower on the modern curve than on the Friedman curve (mean time from 4 cm to complete dilation, 5.5 vs. 2.5 hours). Among the current study’s patients, labor lasting more than 2 hours without apparent change was not uncommon before 7 cm of dilation.”
In this article, “One-third of all first-time caesareans are performed due to active-phase arrest during labour, which contributes to approximately 400,000 surgical births per year in the USA”. According to Aaron Caughey, MD and PhD, in a study, he found that just by being patient, one third of those women could have avoided the more dangerous and costly surgical approach.
More woman having caesareans means more women wanting VBAC’s (vaginal birth after caesarean) for their next birth. They will likely be subject to some sort of disinformation, fear or hurdles in order to have their VBAC – when all they want is to experience a normal birth. Threats of events like uterine rupture can scare many women into repeat caesareans when the risk is actually very low, around 0.7%. You also run the risk of rupture when you are induced but this is not advertised by doctors, instead, it’s often omitted.
It is also common for women to see a break between the first and second stage – from completion of dilation to the pushing phase. The theory behind this is mother nature’s way of recouping some energy, or perhaps it’s similar to the natural alignment plateau… which I will now explain.
Natural Alignment Plateau
The phrase ‘Natural Alignment Plateau’, (which I believe was coined by Dr. Robert Bradley) is a normal, healthy process said to occur in around 50% of births. It makes much sense, especially when you consider the information from the study and article I mentioned above. Here’s some information I sourced from this page on Natural Alignment Plateau:
“Medical personnel deal mostly with dilation, effacement, and station. They also deal mostly with medicated mothers. They are used to managing labors rather than allowing them to follow their natural course. They like to see a regular pattern of progress in regards to dilation. But it is not uncommon for a mother to reach a point where labor continues, but dilation of the cervix stops for a time.
During this time there are many things that may be happening that are necessary for the birth process to take place. Some of these things include:
- Physical alignment of the baby's presenting part in relation to the mother's pelvis. This is something we cannot determine; the baby must find the best way through this narrow passage.
- Softening of the cartilage in the pelvis and increasing flexibility of the ligaments and tendons as the mother's body prepares to accommodate the baby.
- Time for breasts to form all the immunities necessary to protect the baby after birth. Secretion from the breasts prior to the onset of labor are very low in these immunities, yet they are full of them by the time the baby is born- this may require some extra time.
- The baby may be in need of more contractions which massage the baby, stimulate its nervous and prepare it's lungs for breathing on the outside.
- Psychological changes in the mother: Adjust to taking on responsibility of another life; anxiety at baby's first step toward independence; environment where they feel safe and secure.
- Psychological changes in baby. (Evidence tends to support that the baby may be going through psychological and emotional changes during this time).
During this time, it can be very easy for a mom to become discouraged by statements that she may hear. “You're still 5. You're only 5 cm. You're not getting anywhere. You've failed to progress.” These mothers are working very hard in this time and they are progressing, they just aren't dilating. They may continue for many hours this way, or only for a short time, each according to her own needs.
It is very important to for the coach to keep the mother from getting discouraged at this point. Remind her that she is progressing- she's just not dilating. This is very important work that she is doing. It may be a good idea to put off vaginal exams for a while and explain to the medical team that as long as mom and baby are doing fine, you are willing to allow them the time they need.
Case #1: A woman experienced a N.A.P. for 8 hours at 6cm. She chose to go home. When she felt ready, they returned to their birth center. She was still 6cm but almost immediately went into transition with contractions one on top of the other for 5 minutes, then confidently announced that she was ready to push. She gave birth to a 9 lb boy with no episiotomy and no tear.
Case #2: A mother having a VBAC had been in labor 24 hours, many of which she remained at 5 cm. She was tired and in a lot of pain. Dr. recommended breaking BOW to speed things. She was told if she didn't she would probably labor for another 6-10 hours. She declined and within 45 min. the BOW broke on its own and she began pushing. 6 lb 11 oz girl vaginally.
Case #3: A mother had been in labor for about 12 hours when she went to the Dr. office to be examined. She was 2cm. So they sent her home. Within and hour she was experiencing an undeniable urge to push. And barely made it to the birth center where she gave birth to a 9 lb 2 oz boy.
Doulas & Independent Midwives
If you’re worried about yourself or your partner remembering all of this, you can hire a doula (birth attendant) or your own independent midwife for a home or hospital birth. A doula doesn’t cost as much as an independent midwife for obvious reasons of medical training, however a doula is trained in birth support, so they will be able to assist you with tips, tricks and reassurance when you aren’t sure whats going on or if you’re feeling anxious. An independent midwife can do the same, but is also medically trained, so you could have a homebirth or she can come to hospital with you. They have additional training on stalled labour and they tend to know lots of great ways to help get that labour going or letting you know the plateau is normal and you can have a rest.
Unfortunately in hospitals, the only way most of them know how to deal with a plateaued labour is to fix it with drugs, tools or interventions – and who wants to fight for the chance to let their body do what comes naturally in labour?