Labor Extremes: Prodromal vs Precipitousby Elizabeth MacDonald
It seems that the only acceptable vaginal birth is one that follows the not-so-normal bell curve that people assume labor to be defined. You know, the dilating a centimeter an hour, and pushing immediately at 10 centimeters. I’m sorry to tell you that this is far from true for so many birthing women. There are two reasons that doctors will tell you to expect labor to be around 12 hours. The first reason being the “dilate a centimeter an hour” thing and another 2 hours for pushing. (First time moms push over 2 hours on average, but that includes medicated mothers and unmedicated mothers.) The true reason is that studies show an average birth lasts 12-14 hours in length. But you understand how to average, right? You add all the birth hours up and divide by the amount of mothers in the study(ies). So if the average is 12-14 hours, that means half of women will exceed that number and half will labor for far fewer hours. In our society, women who do not follow the “normal” pattern are labeled as having ‘complicated labors.’ In all reality, there is no true ‘normal’ for birth, but instead, a normal for each mother and each baby’s birth. Let’s talk about the two extremes when it comes to timing birth: Prodromal Labor and Precipitous Labor.
Precipitous LaborLabor is considered “fast” or “precipitous” when it lasts three hours or less. This tends to only happen in a small percentage of births. In 2014, the CDC reported that over 21,000 out of 945,180 live births involved rapid labor or express deliveries. This means 2.26% of these births were express deliveries—and that data is just from women who reported risk factors, procedures or some anomaly. I’m betting the number is much much higher than what was reported. Have you read my fourth birth story? (Go READ it!) I didn’t report my experience at all, and I don’t think many women report their labor times. Most published reports suggest that fast labor generally has a physical basis. Possible causes include:
- a particularly efficient uterus that contracts with unusual strength
- extremely compliant soft tissues inside the birth canal
- an above-average “pelvic outlet”
- a well-aligned pelvis, pubic bone and birth canal
- an unusually small baby a baby positioned extremely well to come out
- having a female relative who also experienced fast labors
- premature labor
Precipitous labor comes on like a freight train. Contractions seem irregular, unpredictable, too intense, and never-ending. Handling these without fear is quite an accomplishment. If you are suddenly experiencing contractions one on top of another with little to no rest between them, your body is already transitioning and preparing for the second stage: pushing. Pushing is not controlled. Your body will react without you helping it. The best thing to do is give in and gently aid your body and deliver your baby without panicking.
Other signs that you are having a rapid birth
- A sudden onset of intense, closely timed contractions with little opportunity for recovery between contractions.
- An intense pain that feels like one continuous contraction allowing no time for recovery.
- The sensation of pressure including an urge to push that comes on quickly and without warning. This can also be described as bearing down and feel similar to a bowel movement. Often times this symptom is not accompanied by contractions as your cervix dilates very quickly.
Challenges of a Fast Labor
- Self-doubt: the intensity will cause you to question your ability.
- Emotional hurdles: Digesting the situation will cause a rollercoaster of emotions.
- Calm breathing: Remember to breathe deeply and stay as relaxed as you can.
- Cycle of fear: Fear triggers shorter breaths, and shorter breaths trigger anxiety and panic.
- Unprepared birth environment: This may not be where you planned to have a baby, but grab some towels, blankets, and a bowl for the placenta!
- Physically, a fast labor, specifically a fast pushing phase may increase the risk a mother tearing if her body is not ready to stretch. However, some experts believe whether or not a woman tears has more to do with whether she is working with her body than how fast birth happens.
What to do if you experience precipitous labor
- Call your birth team the moment your contractions show signs of the above.
- Do not panic.
- Remember that birth is natural, and your body can do this.
- Take a hands-off approach: do not pull on baby as he enters the world. Simply be there to catch him.
- Do NOT pull on the umbilical cord. Do NOT cut the cord. Do NOT force placental delivery – let it come naturally.
- Bring baby to your chest and rest until your birth team gets to you – or until you get to them, whatever the plans are after you call and speak to them.
Prodromal LaborThere is nothing false about this type of labor – even though it can be called “false labor.” Also referred to as the latent phase, the prodromal phase of labor is determined by the presence of contractions that may be steady, but do not increase in frequency or intensity. The wonderful thing about a long prodromal labor is that it can shorten the active phase of labor. This is because your body has already done a considerable amount of work to dilate and efface your cervix, as well as move your baby down.
Possible causes of prodromal labor
Emotional Needs Mom may be holding on to emotional ‘baggage’ that she is not even aware of (or maybe she is!) what is prohibiting the start of active labor.
Physical Needs So many things are happening during labor:
- Baby is positioning for birth
- Baby lungs are being massaged with contractions
- Baby nervous system is being activated
- Breastmilk is forming immunities
- Birth canal is aligning with pelvis
Signs of Prodromal Labor
- Contractions feel like Braxton Hicks contractions but sometimes they can be much stronger.
- Unlike true labor, where contractions usually become longer, stronger and closer together, prodromal contractions are irregular in duration, length and intensity.
- They may have a pattern and show up about the same time every day (or night).
- They will stop after a few hours.
- They may or may not be affected by your activity. Sometimes a warm bath will make them go away, and on other days, it may run its usual course.
- Your cervix may begin to dilate, and efface and you may lose your mucous plug.
Many birth professionals feel that prodromal labor is the result of poor positioning on the part of the baby. Sometimes a baby that is positioned “sunny side-up” or posterior will want to move into a more optimal or anterior position. To remedy this, labor is triggered and the body, the uterus and the baby try to make that baby turn into an anterior position. But, after a few hours the body will take a break, only to try again a bit later.
If positioning issues are the cause of your prodromal labor, then there are a few things that may help:
Chiropractic Care: A chiropractor who specializes in pregnancy and families will be a great asset during this time frame. He can help manipulate baby’s position and help align everything for active labor to start.
Position changes: www.spinningbabies.com can be a wonderful resource.
Challenges with a Prodromal LaborIt doesn’t sound fun, but it is possible to have a positive and even natural birth experience with prodromal labor. The bad news is that it can be exhausting both physically and emotionally. The good news is that you and your partner will have lots of practice sessions where you can put into use all the relaxation techniques and positions you learned in your birth class. Often when a woman who has prodromal labor finally goes into the “real thing”- it goes quickly. Your body has been working, warming up, and getting ready for your birth. Prodromal labor isn’t a sign that you don’t work, but the opposite. Your body is actively working to give you the healthiest natural labor possible.
What to do if you experience prodromal labor
- Get some sleep. Try a warm bath and a glass of wine. Take a nap, when you wake up the contractions will be less intense or you will awaken to more intense contractions, rested and ready to cope. Sleep is a lingering labor’s best friend.
- Explore any possible psychological barriers or fears that may subconsciously be holding you back.
- Oxytocin is stimulated by kissing, cuddling, and nipple stimulation.
- Don’t run out of fuel- continue eating and drinking, nibbling and sipping.
- Be patient.
- Know that even if there is a physical reason, such as the size or position of the baby, this is all the more reason why the baby needs undisturbed time to negotiate his way.
These signs may require medical attention: Decreased fetal movement, hard uterus even between contractions, excessive bleeding, discolored fluid from vagina.
I wish you a birth that is no one else’s ‘normal’ but your own! Happy birthing!