Month 9 Labour on strike

When labour puts on the brakes, here’s how to get things rolling again

While we all hope for a swift, controlled labour (as nature intended), many things will influence what happens on the day. The position and condition of your baby on the day, your own physical ability (fitness), the kind of attention and support you get, and the amount of medical intervention that may happen can hugely influence your labour.

Lack of confidence and fear are also big culprits in putting on the brakes during labour.

It is unfair for caregivers to expect all of us to labour in the same way. Hormones control the start and maintenance of labour, and it’s the disturbance of the balance of these hormones that can cause labour to slow or stall. Just like we all take different times to reach an orgasm, we take different times to labour and birth our babies.

WHAT IS STALLED LABOUR?

On average, first-time moms labour for about 12 to 18 hours. For subsequent births, it usually progresses in half the time. But sometimes labour stalls or occurs much too slowly. Prolonged labour is also referred to as “failure to progress” and is the biggest cause of unexpected, non-urgent (in most cases) caesarean-section deliveries. Yet it is not dangerous to labour slowly, especially if you and your baby are not compromised in any way. Sometimes it is more manageable when your body can take its own time to open up. However, slow labour is a common reason women are unable to achieve a natural birth.

Today’s labour patterns show a marked difference from labour 50 years ago. Labour is often longer, and this may in part be due to higher body mass index (BMI), rates of labour induction (often done when conditions are unfavourable for a successful outcome) and the significant increase in the use of epidural anaesthesia. Also, a high percentage of caesareans are currently performed during the latent (early) phase of labour. This happens, even though a prolonged latent phase (prolonged early labour) is no longer considered an indication for a caesar. Prolonged is defined as longer than 20 hours in first-time moms and longer than 14 hours in moms with children.

THE F-WORD

The biggest cause of a slow or stalled labour is fear. When you’re feeling observed, have bright lights around you, and have papers to fill in, questions to answer and are in a strange, medical environment, it’s natural for you to get tense and anxious, which in turn causes your body to put the brakes on labour. You shouldn’t be subjected to all of the above when you’re entering labour and should be encouraged to relax in a dimly lit room with your support team around you. When stress hormones enter your system, your body goes into flight or fright mode, and your labour will stall immediately. Your primal brain (where birthing should take place) picks up distress signals from your body and sends chemical messengers to slow or stop the labour until such time as you’re safe to continue labouring. If you’re anxious or fearful, you may act or react fearfully. To overcome this challenge, it will be necessary to help you feel safe and comfortable again. A doula or midwife can help in getting you to feel safe and at ease. If you’re poorly hydrated, you’re also at risk. Take sips of water or juice, or suck on ice chips between contractions.

COME ON, BABY

Other reasons labour may be stalled include:

■ The baby is big and cannot move through the birth canal.

■ The baby is in an abnormal position. Optimal position is when the baby is head down, facing your back.

■ The birth canal is too small for the baby to move through. (Only a trial of labour can prove this.)

■ Contractions are very weak and ineffective.

The stalled labour may indicate a problem with the baby’s position, such as a head not pressing fully on the cervix, or posterior presentation. Often a baby in a poor position will cause an irregular contraction pattern with short, painful and ineffective contractions.

If this is the case, it may be helpful to use positions and techniques that may help to realign the baby in the pelvis. This should be taught in antenatal classes. Certain positions can be adopted daily, before labour starts, if you know your baby is not in an ideal position.