Preparing for class is always enjoyable for me. This morning, I've been reviewing my materials for class 2 where we focus on the early or "latent" phase of the first stage of labor. In doing so, I've been reading up on Frieman's Labor Curve and the new ACOG recommendation to reduce primary cesareans. It all centers around time--how long is normal, what risks are associated with waiting longer, is labor to be gauged by the amount of time mom feels contraction or her dilation? It seems stupid to me that a massive crew of experts got together and said essentially, "If we wait until more women are actually in labor to admit them to the hospital, we will lower the primary cesarean rate."
That's progress? That took days of meeting and presentations? Admitting women to the hospital just because they are contracting is silly, but it's what most often happens. I cannot tell you how many times I've been told or read things like, "At my appointment, I was having a lot of contractions. You could see them on the monitor, but I didn't feel them. The doctor told me to go on over to the hospital!" There are so many things wrong there. I'm not quite sure where to start.
If you cannot feel contractions, they don't count. Just because you are contracting, does not mean you are progressing much less in actual labor. This is NOT evidence-based care. This kind of care increases risks to you and your baby despite the false sense of control a scheduled birth may give you.
Hospitals must stop being afraid to send mothers home to wait. They must also stop offering social or convenience births. They must also stop rupturing membranes as an initial step in the induction process so a mom can go home and try another day if things just are not progressing. Very rarely do the risks of staying pregnant another day or two outweigh the risks of having an emergency birth, cesarean or vaginal, for you or for baby. Forcing an induction when your body just isn't ready increases risk of forceps and vacuum, episiotomies 3rd and 4th degree tears, and finally a cesarean birth. All of those same risks still apply when you are admitted in early, early labor and the cascade of augmentation begins. I often wonder how many people were actually induced when they think they were augmented.
Another favorite of mine is, "Well, I'd been having contractions for a while, so we decided to go on in." Could you walk? Talk? Were you still laughing, putting on makeup, maybe fixing your hair between them? You can have episodes of contractions for weeks before labor starts. Many women experience prodromal labor almost every night for the last week or two of pregnancy. It's normal. It's not pathological--"I just can't seem to go into labor." No, instead of that try shifting your thinking to: "My body is getting ready." Even if there is no cervical change, those contractions may be helping to position your baby. They give you a chance to practice coping with contractions. Your best bet is to wait and rest up as much as possible. Go about your life until they demand all of your focus and energy.
Care providers must be more patient prior to labor and "allow" a woman's body to start labor on it's own. Most women will begin spontaneous labor between 38 and 42 weeks gestation not 38-40 weeks. A huge proportion of cesareans would not happen if doctors customized care and waited to intervene at 42 completed weeks as suggested in Williams Obstetrics. Of course, that is not always appropriate, but it's up to each care provider to customize care to fit that situation. It's abundantly clear that one-size-fits-all maternity care isn't working out so well.
Mothers have to be better prepared to wait and recognize true labor. Yes, you need more information and support than what your doctor provides. Yes, it's hard to wait. Yes, you are big, maybe uncomfortable, tired, whatever. I've been almost 42 weeks pregnant in August. I knew what the signs of real labor were, and waited out a day of contractions at 34 weeks most likely caused by dehydration and doing too much.
I've been with a mom having contractions 3 minutes apart at 38 weeks. We went to the hospital. She was about 5 centimeters dilated. The contractions stopped...for hours...maybe forever. The nurse gave her the choice--you can stay and the attending doc will want to start piton or you can go home and wait. She went home to wait. The baby came 10 days later. She had the confidence in her body and the information to step back and realize that contractions do not always a birth day make.
I have another friend who just had her baby at 42+3 with the support of a wonderful doctor. It is your choice. It's your provider's job to be honest about what choices are safe and be respectful of your wishes.
There is so much more to early labor, hence we spend a whole 3 hour class focusing on it, but here is the bottom line: it's your choice--your choice to pick a provider who will offer you individualized, evidence-based care; your choice to prepare yourself with information, tools for labor, and patience; your choice to do your best to have a healthy pregnancy; your choice where, when, and how your baby is born.
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