When labour stalls or you are put on a ‘progression timer’

Written by Odile Chaperon

Scenario: You have been in the birth suite for 6 hours during labour and your obstetrician has been coming in and out regularly during the last hour to check progress. He has indicated that things are not progressing as quickly as he would like and has suggested augmenting labour with syntocinon. Each time the obstetrician comes in you become anxious, stress and immediately begin to doubt your ability to birth. So, what support can a doula offer you?

A doula is there as your birth coach, encouraging you and advocating for you as you labour to bring your baby earth side. It is likely that your doula will have run through this scenario with you whilst preparing your birth preferences. Understanding the natural progression of labour is fundamental to saying no – if that is your choice. Your doula will always support your choice without judgment. She is there for you, your birthing partner and your baby, so if your choices change on the day feel comfortable knowing that you will always be supported.

Firstly, asking if you or baby are in immediate danger will enable you to ask your obstetrician for more time (provided the answer is no), and you can ask to be undisturbed for the next hour, at least. You can also ask for no, or less frequent, vaginal exams. If you are concerned and would like more information from your obstetrician about the option of syntocinon, BRAIN technique can help you to make an informed choice:

Benefits – what are the benefits of the suggested intervention, in this case – syntocinon

Risks – what are the risks of augmenting labour with syntocinon

Alternatives – what are the available alternatives

Intuition – what is your intuition telling you about this suggestion

Nothing – what happens if you do nothing

Whether you run through BRAIN and decide to wait a bit longer before intervention, or simply ask for more undisturbed time, your doula can then help you try some different things to help with labour progression. I will be talking about the role of hormones and natural oxytocin production, acupressure, positioning and movement and Spinning Babies techniques. Before I jump in, I want to cover natural progression of labour and why women shouldn’t be put on a timer and expected to dilate in a linear fashion.

Progression of labour

In a nutshell, labour progression is assessed according to a partogram – a tool developed in the 1950s by a man who studied 100 (yes only 100!!!) women and their cervical dilation through labour in an American hospital. What he found was that the average rate of dilation was 1.2cm per hour, with most women giving birth within 12 hours. What his observations also show, but which seems to be insignificant in medical assessment of labour progression, was that the rate was not linear. That is, the women dilated at individual rates. Somehow, the partogram still became a widespread assessment tool, with many hospitals expecting 0.5cm-1cm dilation per hour even though research shows that women vary greatly in their dilation rates and the average length of labour is much longer that Friedman’s finding3.

Knowing this, it doesn’t make sense to expect a woman to dilate or ‘progress’ according to a schedule. Saying no to your obstetrician is your choice and your right, and if you and baby aren’t in immediate danger, your doula will support you in having more time to labour and progress according to your own clock.

Hormones of labour

Hormones play an important role in labour and making sure the right hormones are present at the right time can help with labour progression.  The primary hormone that we want to be present and really encourage is oxytocin – the love hormone. Anxiety and stress are not welcome in the birth suite! Let’s create a beautiful, calm and safe environment for you to birth in.

How can you promote natural production of oxytocin?

  • Making sure the birth suite is a private and safe environment for you (no disturbances)
  • Dimming lights and using battery operated tea lights to create a soft glow
  • Nipple stimulation (you or your partner or a breast pump if you have one)
  • Relaxing music/meditation tracks/hypnobirthing tracks – preferably with headphones which will help keep you undisturbed
  • Alone time with your partner to connect, kiss and cuddle. Oxytocin is produced when you orgasm so don’t be afraid about considering this option! Ask your doula for some alone time and you can let her know when you’d like her back in the room
  • Sucking on a small piece of good quality dark chocolate
  • Listening to or looking at birth affirmations
  • Avoiding interactions where you are made to think

Acupressure

There are some wonderful acupressure points which can assist when labour stalls or isn’t progressing efficiently. Your doula can use the two points below and your birthing partner can also assist. Debra Betts, a renowned nurse and acupuncturist, offers great information and free resources on her website and I highly recommend taking a look – https://acupuncture.rhizome.net.nz

Both Sanyinjiao SP-6 and Hegu L.I. -4 can be used in combination for several minutes. Ideally your partner will hold a point, and your doula will hold the other point on the opposite side of the body. After a 10-minute break, they can swap to the points on the opposite side of the body.

Image 1. Sanyinjiao SP-6

https://acupuncture.rhizome.net.nz/acupressure/problems-in-labour/unestablished-labour/

Image 2. Hegu L.I.-4

https://acupuncture.rhizome.net.nz/acupressure/problems-in-labour/unestablished-labour/

Different positions

Moving your body into different positions can help to open the pelvis and move baby into a better position to create more effective contractions. This might be as simple as walking, swaying, dancing to some music, bouncing on a birth ball or using the CUB (Comfortable Upright Birth) support that some doulas have available for their clients. If you don’t have access to a CUB, you can still use upright positions by using something else as a support.  

Some benefits of using the CUB and upright birthing positions2:

  • Being upright during labour and birth can increase the available space within your pelvis by 28-30% giving more room for baby to be born
  • Your contractions are more effective. Some preliminary studies have shown that an upright position in labour is as effective as oxytocin (syntocinon) infusion in stimulating contractions
  • Your baby is 54% less likely to become distressed during labour and birth if you are in an upright position
  • The length of the first stage of labour (between 3-10cm) can be significantly less when you remain upright, active and mobile
  • Upright positions reduce the duration of the second (pushing) stage of labour
  • Being upright has been shown to result in a 23% reduction in medically assisted deliveries- more space, less distress and a shorter labour results in fewer necessary interventions
  • 21% reduction in rates of episiotomy (a cut made to the area between your vagina and anus) in women who give birth in an upright position
  • 29% reduction in emergency caesarean sections
  • Mothers have a reduced need for epidural pain relief when they are upright

https://www.birthability.com.au/birthability-lamaze-blog/2018/5/26/the-importance-of-upright-positions-in-labour-and-birth

Spinning Babies techniques

Once “where” baby is positioned has been established with the help of a midwife, there are different techniques that can be used to try and help baby move into a more desirable position for birth. A mal-positioned baby can result in ineffective contractions meaning a longer labour.  

 

Technique Purpose When
Abdominal lift and tuck To help baby into the pelvis and through the pelvic brim During contractions for at 10 contractions if possible
Forward leaning inversion The forward-leaning inversion potentially makes room for a good fetal position by untwisting any ligaments to the lower uterus and cervix that may be twisted from sudden stops or a habit of a twisted posture. Kneeling afterward allows temporarily lengthened ligaments to align the uterus with the pelvis. The cervix may become less tipped or tight and then able to let baby’s head to position well, and the cervix to dilate in labour more easily. Through a contraction for about 3 breaths
Side lying release To increase pelvic mobility, make room for the baby  to move into a better position, create longer, softer pelvic muscles for the baby  to move through Through 3 contractions on each side, should be held for at least 2.5 mins
Standing sacral release May help baby move into a better position for labour Can be done at any time during labour
Shake the apple tree Relaxes the buttock muscles and helps create room for baby Any time during labour
Rebozo sifting Relax tight uterine ligaments and abdominal muscles and help baby rotate more easily Early labour between contractions

 

What now?

As you can see, there are so many different things that we can try to help labour progression before resorting to syntocinon. Remember that each woman is individual and will progress through labour according to her own clock. Not the clock established by the average of 100 women back in the 1950’s.

Provided that you and baby are safe and that it is your choice, your doula will encourage and support you to try these techniques and aid your progression of labour safely, naturally and in your own time.

Resources and references

https://acupuncture.rhizome.net.nz/acupressure/problems-in-labour/unestablished-labour/

https://www.cub-support.com/cub-benefits/

https://midwifethinking.com/2011/09/14/the-assessment-of-progress/

https://spinningbabies.com/start/in-labor/tips-for-labor-progress/

My name is Odile Chaperon and I am a doula who has trained at the Doula Training Academy. If you would like to talk more about your birthing options, please contact me:

Business name:     Earthside

Business Website: www.earthsideperth.com.au

Business email:     [email protected]

Facebook:     www.facebook.com/earthsideperth

Instagram:     www.instagram.com/earthside.perth

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About Vicki

My name is Vicki Hobbs and I am a mother of two amazing girls, who due to their age gap have helped me to adapt and become more patient and resilient through life changes, while improving myself on many levels to become who I am today.