By Lauren McClain
The New Early Labor
Early labor is supposed to be the time when you rest, distract yourself, eat, and get into a rhythm for the more intense, active stage. Due to recent changes in obstetrical management of labor, early labor isn’t all like that anymore.
Clinically, early labor now includes everything up to 6cm dilation, which feels a lot more like active labor than it does those first sporadic contractions. The wide spectrum of intensity now included in what we call “early labor” calls for the addition of a stage—what I am calling bridging.
Typically easy, start-up labor is 0-3cm, and the usually more intense part from 3-6cm when your body is gathering momentum is the bridging phase—a link between early and true active labor.
The threshold for active labor changed from 4cm to 6cm in a 2014 bulletin called “Safe Prevention of the Primary Cesarean” released by The American College of Obstetricians and Gynecologists.
The Oxytocin Snowball
Six centimeters is actually a better physiological threshold for active labor because of the hormones involved in birth. Oxytocin, the love hormone, is required to contract your uterus. No oxytocin, no contractions. At some point in labor, assuming you are feeling safe and relaxed enough, an oxytocin loop develops, which snowballs your labor forward.
The momentum of this oxytocin snowball, when labor progresses steadily if not rapidly on its own, is the true marker for active labor. Since we have no good way of measuring the way oxytocin is being produced and used by the body, we use a clock and dilation of the cervix to approximate.
Crossing the Bridge
Waiting for 6cm to call labor “active” means that, in general, interventions (especially to speed labor) will not be employed until later. Doctors say that there should be no diagnosis of failure to progress, labor arrest, or inadequate progress before 6cm—before the oxytocin snowball has a chance to get going.
Laboring those extra two centimeters without intervention can increase your body’s ability to birth normally, so handling the bridging phase is important. Even for women who want an epidural, doing the bridging phase before looking for pharmaceutical help can mean the difference between vaginal and cesarean delivery, between Pitocin contractions and safer, hormonally paced ones.
This obstetrical policy change is physiologically friendly and wonderful for the future of hospital birth, but the greater issue here is a shift in maternal mindset. The rate of risky interventions like cesarean, forceps, and high doses of Pitocin won’t change for women who want to get an epidural before they feel a single contraction. So here are three radical ideas about the bridging phase for safer, physiological birth.
3 Tips for Bridging:
1. Remember it’s OK to leave the birth place with baby still in womb.
If you come to the hospital at 4cm and your labor just stops, under the new rule the staff is supposed to encourage you to go home. If you have been stuck at 5 for the last 4 hours, going home and coming back later may be a good idea. If you go in for a non-emergent induction, you’re 4 cm along, and just not getting anywhere—why not unhook and try again in a couple days? (This assumes your water has not broken and there are no other extenuating circumstances.)
Waiting until 6cm to start tracking labor progression is especially beneficial for women hoping to have drug free, low-intervention births in the hospital.
2. Wait until strong, active labor to arrive at the birth place.
We’ve long known that if you want have a drug-free birth you should labor as long as possible outside the hospital. When you stay in a familiar, comfortable place longer, the natural oxytocin snowball does all the work.
Since a flood of oxytocin happens easiest when a woman’s neo cortex is turned off, I advise my birth class clients to leave for the birth place when mom is acting ‘out of it.’ She can’t remember her phone number, doesn’t care if she’s wearing pants, and/or is in a place of obviously intensifying contractions she needs help with. (Hire a doula!)
3. Work prenatally to feel confident and calm enough to handle early labor, including bridging, out of hospital.
Waiting for labor to begin on its own, the vast majority of women will handle 0-3 cm well if not quite easily. Bridging, the second half of early labor, requires a bit more education, preparation, confidence and calm. A good birth class helps both partners feel excited and capable. Mom is able to relax and let her baby get the oxytocin snowball rolling. The risks of epidural to both baby and mom are significantly reduced when and epidural is placed later in labor.
The Bottom Line
Obstetricians are now supposed to wait until 6cms dilation to start managing labor progression. This should result in a lot fewer interventions in general, including cesarean, and especially for failure to progress. If women are sufficiently prepared and confident to get from 3-6cms without medical and pharmacological aid, we will have a lot more safe, vaginal births.
Lauren McClain is an educator, writer, and mother of three. She is the author of the Breech Baby Handbook and Better Birth Graphics, a collection of time-saving digital downloads for birth professionals. She lives in Maryland where she enjoys teaching Birth Boot Camp classes and hanging around the local birth centers.
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