Failure to progress. According to the Society of Obstetricians and Gynecologists of Canada (SOCG) it’s the number one reason c-sections are preformed. Not because the baby isn’t doing well, not for medical issues that reside with the mother, but failure to progress. What that means is that many c-sections are preformed because people don’t produce “sufficient” contractions to dilate the cervix.
Read that again, our bodies, our perfectly designed bodies, don’t produce “sufficient” contractions to dilate the cervix enough to birth a child. I’ve always had a hard time wrapping my head around this. No other species on earth suffers from this, none. So, what gives?
Well, birth isn’t just a physical process. It’s a mental, emotional and spiritual one also. Under our current model(s) of care, we often birth like animals in a zoo. Not always though, some care providers and birth settings are working hard to remedy this, but often, we do. Think about it, birth has become more of performance; women are watched. Yet, many educators, doctors, midwives and nurses’ opinions state we’re off the mark as a species.
Let’s keep it simple, we are mammals. In a low-risk pregnancy, women really don’t need a lot. For sure, they need a well trained watchful medical eye, but that’s about it. However, the space and environment that people labour under, matters. The more calming the space, the more labouring people can focus and stay in control of their contractions. However, currently most people leave their safe homes (calm), drive in a car, enter triage (where all sorts of people go,) labouring women, pregnant people who are ill, pregnant people who are miscarrying etc…think about it (not calm). That’s just one simple transition from home to hospital. It may sound simple, but a lot has the potential to be happening and all the “happening” can affect your birth. How would you feel listening through the curtain to the person in the next bed who is miscarrying a child? It’s tough.
Labour is like sex, well more like a female orgasm. You need to be the right mind frame, you need to feel safe, you need to feel comfortable in your vulnerability. You need to be with someone who you trust. You need to have minimal interruptions, so you can find your grove, your rhythm and enjoy the flow…until you reach the point of climax. BANG! Essentially labour is the same, you need to find your rhythm (and keep it), your grove, feel safe, accept your vulnerability until you reach full dilation and your baby is born.
Let’s go back and look at how we as a species are birthing again. Essentially, we are like animals in a zoo. Being watched, judged, told what to do etc. We go from home to hospital and instantly the rhythm of labour shifts. We are asked questions (often while contracting), asked to lay down etc., etc., etc. Yet, we expect people to produce “sufficient” contraction under these conditions.
Now, I’m not saying that hospitals are bad. They are bad ass agents who serve sick people. They save lives. However, the rules, protocols and such have the potential to interfere with the rhythm of labour. Rhythm & relaxation are two components that produce sufficient contractions. You don’t need someone interrupting you by asking questions mid contraction, you don’t need the lights being turned on, you don’t need a cervical check every hour, you don’t need…and the list of protocols goes on. I’m writing this so you as a potential mama, simply, know.
Now that you’re aware, let’s talk about what to do with this knowledge. Again, hospitals are bad ass agents who serve people. You are a person. If you are planning a hospital birth, or even a home birth, this is critical information. You never know if, or when, a medical transfer will arrive. For instance, my 3rd baby was our 3rd planned homebirth, turned hospital delivery. Meh.
I digress. When you leave your home, you can expect your contractions may slow down, or potentially even stop. That is because your physical, mental, emotional and spiritual situation is changing, dramatically. It is entering a (potentially) unknown space, with people you have never seen and being asked to perform a task (labour) while being watched, asked to talk, provide a sample of blood, lay down for a cervical check, a heart monitor read etc. It’s a massive interruption to your cozy established rhythm. Remember, trust, vulnerability, safety and comfort all lead to your rhythm, rhythm lead to your baby, just like sex, but the big “.O.”
However, don’t fear. You can control many of the things that will come your way. Triage is often coo coo bananas, but once you are settled into a labour and delivery room, SET the SPACE. Plan it. As part of your plan, my advice, ask the care team to only ask you questions between contractions, ensure your support team is aware so they can advocate for you too. In addition, ask them for an hour of alone time to establish your rhythm; lower the lights. Go back to what you were doing at home. Walk, talk, breathe, visualize, vocalize, move, sway, moan etc. Connect with your baby. Welcome your labour back and relax into your new setting. It’s an assimilation period.
Once your labour has established itself again, it is important to keep the space. By space I mean safe, calm, limited interruptions to the person in labour, dimly lit etc. FYI, low lights = more oxytocin = stronger contractions = more feelings of love = faster birth…most times. You got this. Now that you know what has the potential to happen during your transition to triage, you can plan and accept the process.
What causes failure to progress is a debated topic. Fear of birth, lack of prenatal education, unwilling to accept the process, previous trauma, the list goes on. No judgement! However, many care providers agree with the above (that setting the space matters) and there is plenty of research to support it. Many providers are striving and making headway in all sorts of birth settings. If you’re Canadian, check out the Markham Stouffville Hospital…or maybe don’t, you might be jealous and sad.
Keep it simple, humans have been doing this for eons and birth still looks this way in many industrialized nations. Less is more while walking through a low risk labour. Less interventions, less talking, less lighting, less interruptions. Honour the space that a woman is in. Support her by offering words of calm encouragement, simply holding her hand or wiping her face with a cool (pick your favorite essential oil) infused cloth. Go back to the basics…
Gestate well loves,
This topic may be a point of contention for many, but it is something that deserves being aired out. I’m just going to go a head and say it. The last thing a labouring person (potentially you) needs in the delivery room is a support person who has no clue what is going on. Whether it be your mother, partner, husband, sister, aunt etc. Let me repeat it. The LAST thing a labouring person needs in their space is a support person who has no clue what is going on.
Now, lets set a few things straight. I’m not saying that a grandmother or father shouldn’t be in the delivery room. No, indeed they should be there, if that is what the mother wants. However, let’s unpack this a little bit.
Labour is no joke, it’s hard emotional work, hard physical work and spiritually a transformation is taking place as well. When you are learning to do new things, you need leadership; we all know that the type of leadership makes a world of difference.
There are good leaders and bad leaders. In labour, people need a leader with a clean emotional slate, someone with support skills, someone who is comfortable enough and not phased by labour that they could eat a sandwich during the process. I don’t advise eating a sandwich if you are a support person unless you’re on a break though.
If your main support person is your mother, fine. However, be mindful of what she is bringing into the room. Her energy will set part of the tone. Consider this, what type of birth did your mother have? What type of birth are you trying to have? Do your birth ideas align? Same, if your main support person is your partner/father, fine, but have they actually attended a live birth before? If not, how do they know how to support you? Personally, it's an unrealistic task to ask of someone. If you say "how are you going to support me" they are likely to reply with "by doing whatever you want/need." The trouble and truth of it is, they don't know what you need. It's impossible to know unless you have experience.
What often happens is they do their best, they really do. They try and support you, but often times, upon looking back, most people say that they didn't really know what to do and wished they had additional support and continuity of care. Think about it, it's a BIG ask to put your sole trust in someone with little or zero experience. My advice, have a honest conversation about whether your main support person feels comfortable advocating for you, feels comfortable navigating the medical institution, feels comfortable enough to eat a sandwich while watching you crown, is able to detach emotionally and provide objective support. The conversation may surprise you. This is an excellent book, The Birth Partner, for you and your main support person to read.
In addition, when working with clients as a labour doula, one benefit is that I am not emotionally involved on an intimate level. I mean shit gets intimate, fast, but I’m not bothered when a labouring mama cries out in pain. The difference is, I or the medical staff can suggest a new position after a long labour stall and she will likely comply, whereas if her partner were to ask, she will likely tell him to fuck off. Moreover, partners and grandmothers are blinded by love. Their emotions often cloud the support that the labouring mama really needs.
Want to know more about a doula? Watch below...
The point being, women in labour need leadership, the last thing they need is sympathy or empathy from a bleeding hearted grandmother/partner. Don’t get me wrong, women need sympathy, love, empathy, but that only goes so far. As a doula, I have the privilege of giving all of the above, but you also have the ability to coach the family. To help them through the difficult moments by holding space, by encouraging them, by believing in them, but more importantly, you do this from a clean emotional and objective state. I am honoured to hold clients hand, to wipe their tears and to witness the magic of birth.
If you think you can't afford a doula, or find continuity of care through a provider, do your research, the options in your community may surprise you. Many hospitals have doula programs that are free, many local doulas work on a sliding scale, sometimes even free or for a trade in services. Don't be shy to reach out and ask....all people in labour deserve to have a grounded, humble and supportive guide.
Oh, you’re pregnant, how lovely. Can I ask what you're having? Oh, you just wait girl, labour is a bitch, that shit hurts. Okay, next...mine was 48 hours of pure hell. We have all been subjected to horror stories. It’s as if women like to out play one another. Seriously, when was the last time you hear a positive birth story? Have you ever? If you haven't, ask me, I have hundred's to share.
My wish for future birthing women, is that the use of fearful and non-supportive language would stop. Does labour hurt, yup, but pain is subjective. Labour is intense as f%#, but so are a lot of things we mindfully choose to do in life. Um, exercise, say running a marathon for instance, or hiking, or fill in the blank with anything physical activity, really. Crap, sometimes mowing my lawn hurts. However, the point is that the way we frame birth and the language we use around it – hurts.
I’m going to present you with two scenarios and you can see how a few simple words can impact a situation.
No joke, this is a real situation I’ve been in as a labour doula.
Eve is a first-time mother, she is in labour and having a little boy. Eve and her partner, Cedric, are very excited and open minded with their birth plan. They have taken a prenatal class and feel ready to cope with labour with their learned breathing techniques. After a morning of labouring smoothly at home, contractions start to come closer together – 4 minutes apart. Eve and Cedric know they are supposed to go to the hospital because their childbirth educator stressed that when active labour starts, they should consider transitioning to the hospital. Now they are very excited.
When they arrive, they are greeted by a friendly staff member that states the following. “Welcome to the birthing centre, I can see you are working hard with your contractions, we will get you into triage soon.” As Eve and Cedric settle into triage, they are greeted by the nurse who is accommodating and encouraging. When she sees Eve start a contraction she encourages her to breath through it and to move her body physically to help cope with the pain. The nurse asks them the typical triage questions, i.e. have you been out of country? Around anyone with an illness? Any allergies? However, another contraction starts, and Eve needs to concentrate and breathe through it stay in control. This time she relies on Cedric for help by squeezing his hand. Cedric calmly encourages her by stating, “good job, you’ve got this, breathe with me, in and out, in and out…” until the contraction ends. When it is time for a cervical exam, the nurse asks Eve to lay back and let he know when she is ready. The nurse confirms permission before proceeding with the exam by stating “You’re going to feel a touch, are you ready?” Eve’s labour keeps progressing and contractions are staying stable and steady in intensity.
Back to the birth plan. Eve and Cedric are planning to use as few interventions as possible but are open to what Mother Nature directs. Keep in mind Eve is a low-risk pregnant person; she really can choose anything she likes. The triage nurse is supportive of this and provides a few tips for Cedric to help Eve cope before they transfer to a labour and delivery room where Eve and Cedric will meet a new nurse and labour away until their baby is born.
No joke, this is a real situation I’ve been in as a labour doula….
Let’s pick up here… After a morning of labouring smoothly at home, contractions start to come closer together – 4 minutes apart. Eve and Cedric know they are supposed to go to the hospital because their childbirth educator stressed that when active labour starts they should consider transitioning to the hospital. Now they are very excited. When they arrive, they are greeted by a friendly staff member that stated the following. “Welcome to the birthing center, how can I help you?”
Eve “I’m in labour and would like to be admitted to the hospital.” Staff member, “first time mom, so you think you’re in labour, we’ll see.” Eve and Cedric enter triage and Eve is asked to lay down. The triage nurse does need to monitor the baby and get a read on where things are with labour – all normal. When Eve starts to have a contraction the triage nurse is actively asking her questions about her health history and basic intake questions. Again, all normal, but no words of encouragement, space to focus or support given. Another 4 contractions pass, and Eve is being asked to stay as still as possible as a cervical exam is needed to assess how dilated she is. No biggie, all part of the process (for some). The nurse states that she is 4 centimeters dilated and "stretchy", that the worst has yet to hit.
See the difference? As a labour doula when I support families in scenarios as such, I call it birth deflation. When a family comes in ready and willing to do the work, but are deflated at the front door. It's bull crap! Language matters a lot to a labouring mama. If she is encouraged and supported, labour is known to go faster. Her mind will stay in a more positive and accepting space. She will remain more welcoming of the process and les interventions are lower. More importantly, the associated and perceived level of pain is lower.
Labour is a vulnerable, yet empowering experience for a mama to navigate. Most of us will bat off negative thoughts a few times throughout the process, but the difference is that you OWN the negative chatter. As a labouring mama, you shouldn’t have to bat off and carry the weight of another person’s subjective thoughts, beliefs and values when it comes to birth. They aren't yours and they don’t help you by any means.
Again, language matters, choose your care team wisely, and if you end up with a grumpy old crab, water off a ducks back mama. Ask for a new nurse! You hold the power to decide who comes in and out of your birthing space. You might as well fill it will supportive people. ESPECIALLY if you are aiming for a natural birth. Not to discount epidurals, they are bad ass too. Just saying. However, this makes a world of difference for a natural birthing mama.
Labour Anatomy 101
Let me start by saying that if you are a woman, your body is designed to grow and birth a baby. Do I believe that is a woman's soul purpose? Hell no! However, my point is that your body is physiologically designed to grow (you have a uterus) and birth (you have a birth canal) a baby.
Let's talk labour anatomy & hormones. Birth isn't rocket science, it's a complex process, but it's quite simple when you break it down. Let's start from the top. So, you have unprotected sex, or the condom breaks, or you go through IVF treatments. Whatever the situation is, a sperm meets an egg and viola, a little bundle of cells start to multiply, attaches onto the uterus (implantation) and starts to grow. It grows and grows and grows until it is full term. Just an FYI, full term is somewhere between 37 and 42 weeks. Yes, you are technically due for 5 weeks, 40 weeks is just an estimated due date. Your uterus does not have a calendar attached.
If you want to check out one of my labour anatomy videos, you can find them on YouTube. It covers a lot of the same content.
This is where it gets a little more complex. No one really knows why or when labour will start. Some researchers believe that the baby releases oxytocin as a signal to initiate the process. Conversely, some believe that the mothers body releases oxytocin first. For those of you who don't know, oxytocin is a hormone that is released from the hypothalamus (a fancy part of your brain) and tells the uterus to contract. It's also the same hormone that floods the body when you fall in love. Funny huh! However, before the uterus starts to contract another hormone is released to soften and move the cervix, namely prostaglandin.
What we know for sure is that prostaglandin and oxytocin are two hormones that initiate labour. Think of those two hormones like a drip, at first, they start slow and steady, building up to a larger drip as labour progresses along. Now, as the uterus contracts a few magical things are happening. One, uterine muscles are pulling the cervix up into the wall of the uterus. Most of this muscle building happens at the top part of the fundus. As the cervix is being pulled up the result is that it starts to dilate. Two, a different muscle group gently pushes the baby down. Simply put, the two muscles groups work together, one pulls the cervix up and builds a big wall of muscles at the top of the uterus, while another helps by gently pushing the baby down.
There are other hormones at play during this process too. If you are relaxed and welcoming of labour, you will be releasing lots of oxytocin and prostaglandin, but your body is super smart and has a built-in antidote to labour pain. The antidote is called endorphins. The combination of the three hormones is a powerful cocktail. They keep you relaxed, feeling content, loving etc. I have been in labours where women literally fall asleep in-between contractions and slowly rouse when the next contraction starts. A euphoric like state. It’s amazing to watch. However, that is not what we commonly see on the media. That’s another blog post though.
Moving forward, the above isn’t true for everyone. Some people are not welcoming of labour, some people are rattled with fear and are not accepting of the process (no judgement, girl!). Not surprisingly, their bodies produce stress hormones, namely cortisol. Now, cortisol is an important hormone, but when in stressful situations it acts like a fight or flight response. Therefore, it can interfere with the production and release of oxytocin and prostaglandin, potentially making labour longer and seem much more painful. The antidote to cortisol production is simple. When women are accepting, supported and encouraged during labour their stress levels remain lower. Easier said than done when we constantly inundate women with fearful images of birth in the media. Again, another blog post, ha ha.
I digress, one way or another, the body will work hard and hopefully the cervix will dilate to 10 centimeters. When it does, your labour may potentially slow, so you are able to rest. What I mean is that it isn’t uncommon for contractions to space themselves out. I have seen women contract every 2-3 minutes during transition (the last 2 centimeters of dilation) and then every 5 minutes once they hit 10 centimeters. I have witnessed people rest for upwards of a 20-minute period just before spontaneous pushing starts. Now, during this rest think about what is happening, you’re not just chilling, no, no. They body is super crafty. During this phase your perineum (the area between your vaginal opening and anus) is being flooded with hormones. These hormones tell it to become malleable and stretchy so by the time you are pushing out your new babe, it can handle it like a boss. That’s right, your vagina is a BOSS.
So, the long of the short of it is. The more knowledge you have, hopefully you become more comfortable with the process of labour.
If you want to check out one of my labour anatomy videos, you can find them on Youtube