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Friendly reminder that I am just a rambling internet lady, sharing what I have learned about birth, not your mom and not your doctor.
The beginning of this post relies heavily on the Evidence Based Birth article on Freidman’s Curve. I highly recommend you read it in it’s entirety.
I refer frequently to the resources from the EBB website and encourage all to become familiar with her work as well, including her recent book “Babies are not Pizzas; They’re Born Not Delivered.”
Whew that’s a lot of disclaimers 😉
Failure to Progress… or something else?
For a period of six years in the mid 2000’s, 13% of ALL primapara mothers in the United States (over 38,000 women) gave birth via C-Section due to this vague reason: failure to progress.
Interestingly, more than 40% of those mothers who ‘failed to progress’ never even reached more than 5 centimeters of cervical dilation before they were determined to have failed, and were subsequently taken to surgery for cesarean delivery.
Considering that active labor begins when a woman’s dilation reaches 6 centimeters, almost half of the over 38,000 women in this study were in the beginning phases of labor, may have possibly only been in the latent phase, or may even not have been in labor at all! (Read more here)
How would you like to be told “you’re not dilating right!” when you weren’t even really in labor?
Friedman’s Curve, An Old Gold Standard Now Outdated.
In the 1950s a doctor named Emanuel Friedman did something no one had done before: he observed hundreds of laboring women, charted the time it took them to dilate, and plotted their numbers on a graph.
This graph is known as The Friedman curve, and was used as the gold standard to measure rates of cervical dilation and fetal descent of laboring women for many decades.
The curve also seems to be the birthplace of the clever but false “1 cm an hour” rule that women and health providers used for many years.
There are a few problems with Friedman’s curve, (a not insignificant item being the frequency of cervical checks the women must have endured, one is enough for me, thanks!) including this extremely relevant information: the laboring patients he observed were given Pitocin to speed up their labor! (As well as many of them being sedated with the then popular “Twilight Sleep” drugs Demeral and scopolamine.)
How could his results be applied to all women, everywhere, as the normal baseline, when his data was based off women whose labors were augmented and drugged?
I’m happy to report that although The Friedman Curve was used for many decades, in recent years it has been definitively marked as obsolete by modern researchers.
Please refer to the Evidence Based Birth article for more information regarding how long it takes women to dilate naturally, why having a “long” first stage of labor does not affect infant mortality, and why women should be given more time before induction. I would love to talk more about those topics, but I fear they are beyond the scope of this blog post.
Labor is not Linear
Women can be in the early phase (latent phase) of labor for hours, and even days.
Women can labor quickly, then slowly, then quickly again.
Some women have a baby in 30 minutes, some women have a baby in 24 hours.
My second birth was strange, I had contractions 10 minutes apart and 1 minute long the ENTIRE 10 hours, right up until my daughter was born.
Labor can even back track, as noted in Ina May Gaskin’s important book “Ina Mays Guide to Childbirth”.
In her book she includes several reported events of women’s labor stalling, stopping, backtracking, and resuming at a later date due to reasons such as being discomfortable, afraid, and shocked (especially towards a male doctor being present in the room, which was quite rare in the 1800’s.)
One particularly intense sounding historical account of a non-linear labor was this: one doctor (Betschler, 1880) mentioned a case in which the woman’s contractions suddenly ceased, her cervix “though widely dilated, closed again” and her labor did not resume for over 19 days! (Found on page 140 of Ina Mays Guide to Childbirth)
“Some women it seems, can just suck their babies back in if they really don’t like the way things are going.”
Ina May gaskin
Well put, Ina.
This study also words it plainly:
“Cervical dilation during ‘active’ labor is often conceptualized linearly, a conceptualization that likely contributes to the high frequency of dystocia diagnoses and subsequent intervention. In reality, dilation patterns during labor are not linear.”
There are many, many reasons why a labor can stall, pause, stop, reverse, or speed up.
These include baby size, fatigue, time of day, (did you know that spontaneous vaginal deliveries are more likely to happen at night?) birthing position, and notably, fear.
Fear. Fear slows labor.
And unfortunetly, the birth culture in this country is largely a fear culture.
Women are taught to be weary of birth.
It’s everywhere.
Terrifying media portrayals, gossiping grandmothers, horror stories from your friend’s friend’s friend, outdated birth practices, cultural myths, wherever the fear comes from, women have almost been conditioned to distrust one of the most important (if not THE most important) normal physiological functions of human beings.
(The phrase “Fear conditioning” has been used, here.)
Certainly, fear isn’t always a bad thing. But in childbirth, fear can be detrimental.
Fear affects births.
Casual perusal of the internet shows that fear, or at the very least nervous uncertainty, seems to be the prevailing attitude towards childbirth. In a time where information and education are so freely and widely available, I find that very disappointing.
Education regarding childbirth can overcome fear.
I believe it is important for women to learn all they can about birth. And I believe it is important for people to not scare, pressure, time, or otherwise bother women regarding their birth.
One of my favorite books on preparing for childbirth is “The Thinking Woman’s Guide to a Better Birth.” Henci Goer does a great job briefly outlining the pros and cons to many birth choices, although she is admittedly biased towards home birth. (So am I 😉 )
I realize that no one can know everything about birth, that is why we hire certified healthcare providers, to assist us in making OUR birth decisions.
But knowledge is so empowering! Fear of the unknown can fade through learning even a little bit about birth.
Rejecting sensationalized media can overcome fear.
One study found that: “Fear of birth scores were highest among students who reported that the media had shaped their attitudes towards pregnancy and birth.”
Makes sense.
And here is a very interesting report:
An article in the Journal of Perinatal Education suggests that one of the reasons women today are so fearful of birth has to do with its negative portrayal in the mainstream media.
The author provides examples of how these influences, as well as the way hospital births today are “managed” with technology and ‘fear-based’ attitudes can single-handedly convince most women that their bodies are incapable of birthing without major medical intervention and that they would be crazy not to want all the technology they can get their hands on.
In other words, their fears are often generated by what they have seen, heard, or experienced. They may also be generational in the sense that they are “old” memories of the experiences of our mothers and grandmothers.
The fear itself may be conscious or unconscious.
Sally Dear-Healey, Ph.D., PPNE, CCE (BWI), CD (BWI), TICP, formatting mine
It is undeniably true that childbirth can and does involve risks to the mother and infant, but these risks are quite simply part of being alive.
Luckily, we live in a modern age where medical advancements can and do save lives, and most birth complications can be handled in a nearby hospital. And, statistically speaking, odds are in your favor for a healthy delivery.
But even the ACOG reports that: “Many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor. “
Women are capable of birth.
Worrying, stressing, and fearing, won’t help the natural risks to go away, but in fact it may actually contribute to complications.
Consider these statements:
- “Fear of childbirth poses substantial risks to healthy adjustment from pregnancy through birth and into the early postpartum period.
- Fear of childbirth in early labor predicted the total amount of pain medication used during the labor
- Fear of childbirth and negative birth experiences are linked with depression, all of which can lead to poorer mother-infant adjustment in the perinatal and postpartum periods.” Source
Associate Professor Hannah Dahlen of the Australian College of Midwives said:
“Fear increases the release of adrenalin, which impacts on endorphins – a scared woman is more likely to have an epidural.”
The hormones that surround birth are vitally important to how labor progresses. Adrenaline can stop a labor, Oxytocin can ease labor pains.
Unchecked fear cannot be a part of that equation. For birthing women, peace, or at least hope, is vital to success, especially for unmedicated birth. (That, and patience.)
Babies come when they come. You feed them on demand, why not birth them on demand too?
Yes, sometimes they need assistance. That’s okay.
But maybe the problem isn’t that women are ‘failing to progress’. Maybe its something else. Maybe its fear, maybe its impatience.
It’s no secret that medical interventions are often over used, or used too soon. But:
“Evidence suggests that if a person is in normal labor (not induced), and if they are less than six cm and their labor has stalled, then this is not true “labor arrest” and they should simply receive supportive care.”
Evidence based birth
The point I’m trying to make in this post is this: medical opinion is constantly changing. And that’s okay. The scientific method works by making a hypothesis, testing it, and trying another.
But one thing that has never changed in all of human history is woman’s innate ability to birth.
Conditioning a woman to think she ‘cannot do it’ for whatever reason, or provoking fear, is not conducive to improved outcomes for birthing women.
“A normal physiologic labor and birth is one that is powered by the innate human capacity of the woman and fetus.” Source
Fortunetely, many hospitals around the country and around the world have begun to adopt “Mother Friendly” initiatives, and are attempting to return to elements present in the midwifery model of care.
(Use of Midwives is rising in the United States, as well as notably in the UK and Sweden where Midwives are integrated into the mainstream model of care much more effectively than in the US.)
We no longer live in a culture that embraces the beauty of birth. Women don’t see it, daughters don’t take part in it. Sisters, aunts, and experienced grandmothers no longer aide each other in their births the way they used to.
Women no longer grow up naturally observing this inevitable part of life, being taught how it works, how to cope, what is normal, or how to succeed.
In some respects, women are largely left on their own up until the day the baby arrives. And sometimes even thereafter. Where’s the support?
The experience of trusted women is vital to the support system of a laboring woman. The wisdom and experience of those around her should encourage her and strengthen her confidence in herself and her own ability to succeed like the many women before her.
Ina May’s amazing Ted Talk “Reducing Fear of Birth in US Culture” deserves a mention here. It is a must watch! She insightfully says “We are the only species of mammal that can doubt its capacity to give birth.”
I have experienced a few births so far, and I know first had the importance of positivity, patience, peace, and faith in having a successful and even blissful delivery.
So here is what I conclude:
Birthing Women Need:
- Support
- Peace
- Time
- Ability to be in control of themselves
- Reasonable understanding of different outcome scenarios, and willingness to accept the birth she is given
- Some sort of connection to the divine, the woman’s inner instinct, the primal self, and the ancestral wisdom women have always carried inside them that teaches them how to birth.
Birthing Women Could Do Without:
- Guilt
- Fear
- Failure stories
- ‘Advice’ that inadvertently takes away a mother’s self confidence and self efficacy.
I say aim high! Let the rest fall where it may.
If you don’t labor ‘according to the chart’, that’s okay.
YOU have the ability inside you to bring this baby into the world.
Everything else is just here to support you.
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