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Doulas and the Long Labor

Have you attended a long labor yet?  By long, I mean, a birth requiring labor support for more than 24 hours.  And really, 24 hours sounds lovely compared with some of the lengths I’ve attended.

I will do just about anything to prevent a long labor.  But it has taken years to find ways to recognize the signs that a long birth is on the horizon and to keep the mom engaged in the follow-through.

Recognition:

In my experience, long births are tricksters.  The waves are coming closer together.  Mom is releasing adrenaline and the tell-tale signs of transition appear.  She may even feel little urges to push at the peaks of the waves.  The doula often thinks, “This is it!” and transports to the hospital  or calls the midwife only to find out mom is 2cm.  In a little while, the waves space out.

This repeat building toward transition and then puttering out is one sign of the long labor.  At one birth I attended, the couple went to the hospital three times because of this pattern.

Another sign may be that the waves are short.  Perhaps less than a minute long.  While I have attended one or two births that were characterized by consistently short waves the entire labor, this pattern is unusual.  Or perhaps, the waves are at first long and then later they last less than a minute.

The mom may complain of back pain.

The final sign is instinct.  I have learned to pay close attention to flashes of memory or insight that come during birth.  I remember once I arrived at a birth and when I greeted the mom, immediately a memory of a former student popped into my consciousness.  I dismissed it.  What followed?  I was completely tricked by a birth that lasted over 50 hours.  Guess what?  The birth was almost identical to that former student from two years before.  Was this some magical power?  No, of course not.  My instincts probably picked up on subtle clues prenatally when I felt baby’s position.  Instinct is a powerful assistant.  When we listen.

Reasons:

Most of the time, long labors happen because of baby’s position.  The top two are:

Posterior–baby is facing mom’s belly.

Asynclitic–baby’s head is tilted toward her shoulder.

It may also be that baby is still high in the pelvis (not engaged), baby’s chin is not tucked, or baby’s hands are up.

Prevention:

Until recently, I tended to be a little bit tentative when encouraging techniques to reposition a baby.  I didn’t want to ask the mom to do something that would increase her discomfort and I wanted to trust birth, all that jazz.  A doula is meant to soothe and help with discomfort; not make things more intense!  But an ounce of prevention…

There are many techniques in the doula playbook.  They have names like:

  • The Miles Circuit
  • The Rotisserie
  • The Abdominal Lift and Tuck
  • Walcher’s Trochanter
  • Rebozo
  • Psoas Resolution
  • Open Knee-Chest

Sometimes it is hit or miss to find the one manuever that works for this labor.  Please remember to remain balanced during this process of elimination so that the birth team rotates rest and nourishment with the calisthenics.

Which brings me to:

I believe a long labor was avoided with one of my clients.  I recognized the signs:  waves varied from long and close together to short and spaced.  Over the course of about 9 hours, I rotated rest, nourishment, techniques.

The techniques that I thought should work, didn’t.

I encouraged the couple to have some private time and I sat in my car thinking it through.  I wrote down what I knew about this birth and what we had tried.  When the couple was refreshed and rested, I decided to try the Pelvic Floor Release.

I don’t use this technique often.

After a nice bath and rest, I asked the mom to give it a try.  With dad and I supporting her, she began.  She completed three waves on her right side and then we switched to the left.  Around the second wave on her left side, I heard the change.  Her waves became powerful and long.

We followed the Pelvic Floor Release with the Rotisserie but I’m not sure it was necessary.  Within an hour, we were on our way to the hospital where she 8cm!

Conclusion:

From now on, I will arrive at births with techniques a-flyin’.  Perhaps I’ll carry a clipboard and wear a whistle.

No!  These manuevers are still interventions.  We should practice watchfulness and instinctual awareness.  IF they are needed, we should keep our tone positive and tread oh-so-carefully into the birth space.

However, we should not be afraid to move from gentle support to a more firm encouragement.  We’ve seen the result of a long labor and we want to avoid that if possible for our clients.

 

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2 responses »

  1. How ironic that I read this then just attended a birth with a mom who had a long early labor and excruciating back labor. She tried the pelvic floor release (two contractions on each side) and then attempted open-knee chest, lunges, belly lifts/abdominal lift and tuck, all of which she had to abandon before completing because the pain during contractions was so intense. Contractions were anywhere from every 10 minutes when laying down (able to rest in between but boy, that’s an unpleasant way to be woken up) to 5 minutes apart, some closer, most at least 60 seconds or longer, when she stayed standing. She’d pretty much given up hope of having an unmedicated birth when she decided she had to go to the hospital. Throwing up seemed to change the baby’s position because she had much less back labor after this, for which she was very thankful and went on to have her baby naturally.

    So I’m wondering, what do you do when mom can’t seem to tolerate the positions needed to potentially make change? I had a feeling about this mom, too, during prenatals and her early labor. Baby was usually ROA prenatally when I asked and seemed to be LOA or LOT based on the fetal movements we could see and she could feel during labor but later at the hospital heart tones were way off to the right side so who knows. She also felt lots of pain in the left side of her back at times. Next time I’ll recommend probably recommend the Miles Circuit, pelvic floor release and forward leaning inversions BEFORE labor or in really early labor. It can’t hurt and that way at least mom has had experience with them before.

    Reply
  2. I’m so glad she was able to move forward. Hoorah for throwing up. 🙂

    Such a good question. The positions are hard. And I have had moms who couldn’t tolerate them. And the techniques often work only when used long enough. 20 minutes of knee-chest probably isn’t going to make much change. But 40 minutes is tough to hold. The rotisserie works best if it is completed twice. But that can take 2 hours.

    I think we have to pay close attention. Is it that the position is hard? Or is it that her body instinctively rejects the position?

    If it is hard, I draw on my cheerleader background. (Yes. I was.) Praise is powerful. I also sometimes offer incentives. At one birth, after each position change, I had the dad read an affirmation. It gave a sense of completion and maybe motivation. In these situations, I think the doula and the dad need to keep hands on and verbal support coming. This is an area that I used to say, “Oh, I know it is uncomfortable. You don’t have to do it.” Now, I’m more, “Oh, I know it is uncomfortable. You’re almost there. This is making big changes.”

    More recently, however, I suggested a position to a mom. She had earlier completed 40 minutes of knee-chest which is a HUGE challenge. So I knew she was willing. But as soon as she moved into the side-lying position, she jumped up and said, “No, that is not good.” In that case, it seemed to me that her body was recoiling from that movement for a reason.

    I like the idea of practicing positions before labor so the mom gets comfortable with them.

    Reply

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