Long labour survival guide

Pat Millar was well prepared for the birth of her long-awaited first baby. She’d read every childbirth book she could get her hands on. Millar and her husband, Phil Wilson, attended two series of prenatal classes — one offered by the public health department and one taught by an independent childbirth educator.

But even with all that knowledge crammed into her brain, Millar found herself feeling overwhelmed and exhausted as her labour topped 40 hours.

It started out like any other labour, says Millar. “I woke up suddenly at 12:05 a.m. on my due date and realized I was having a contraction,” she says. “And when I went to the bathroom, I found mucusy blood in my underwear. I was very happy and excited, but I let Phil sleep until about 6 or 7 a.m.”

Millar and her husband spent the day walking around and trying to relax. By four that afternoon — 16 hours after that first contraction — Millar decided to go to her doctor’s office to see how things were progressing. “She told me I was about three or four centimetres dilated and nowhere near ready to deliver. We were disappointed — all those hours of contractions and this was all I’d accomplished — but we went back home.”

At home, Millar continued to pace around the house. Finally at 5 a.m. the next morning, she headed to the hospital. “A very cheerful, businesslike nurse told me that I was about six or seven centimetres dilated and would have a baby soon,” she recalls.

Seven hours later, with no baby emerging, Millar says “the nurses began to be less cheerful.” Her doctor decided to rupture her membranes, but she says this seemed to make very little difference in the intensity or effectiveness of her contractions. An IV was started to stimulate the labour with Pitocin.

“The contractions did get stronger; by now I was tired and, thanks to the IV, I was less mobile and stuck in one position in the bed,” Millar recalls. By 4 p.m. — 40 hours after the first contraction — she had dilated nearly 10 centimetres, but was not feeling an urge to push. Her doctor called in two others to consult; one recommended waiting a bit longer and perhaps using a vacuum extractor if no more progress had been made. The other said, “Let’s get that baby out,” quickly performed an episiotomy, then used forceps to deliver the baby. Millar’s daughter Heather was born at 4:11 p.m.

The lessons Pat Millar learned during her long labour paid off when her sister, Noreen Millar, was giving birth.

“I went to bed on a Wednesday night and was awakened at 3:30 a.m. with my first contraction,” Noreen remembers. “I was so excited, I could barely get back to sleep, but I managed to get a little more rest. I got up at 7 a.m. to call my labour support person and as I was standing up, talking to her on the phone, amniotic fluid began running down my leg.”

With her sister’s experience in mind, Noreen (who is a single mother) had hired a doula and planned to have her sister with her as well. After talking with her doula that morning, she spent the rest of the day at Pat’s house. “I was having regular contractions, but they were really very mild. Of course, I didn’t know they were mild because I’d never experienced this before.”

As evening approached, with nothing much happening, Noreen went home to try to sleep, and Pat stayed over at her house. By morning, the contractions had stopped. “I called the doctor to tell her what was happening, and she said that I hadn’t really been in labour. When I mentioned the amniotic fluid, though, she thought I should come into the hospital to be checked out,” she says. Noreen and her doula headed to the hospital, then waited five hours for the doctor to arrive and check that all was well with mother and baby. Contractions had started up again by that point and although they were stronger than before, the doctor sent her home again.

“During the 15-minute ride from the hospital to my sister’s house, labour seemed to be going very well,” Noreen recalls. In fact, after a few minutes “the contractions began to hurt, and I just couldn’t relax sitting in the car.”

Back home again, Pat urged Noreen to get into the bathtub to help her relax. Big sister then hurried home to put her own children to bed. “That was about the worst stage for me,” says Noreen. “I don’t think it helped me to be alone at that time. I was shaky and tearful sitting in the tub. Finally I called my doula and said I wanted to go to the hospital to get something for the pain.”

Around midnight — and that’s midnight on Friday — Noreen, her sister and her doula arrived at the hospital. Noreen was already feeling an urge to push, but felt the position the nurses and doctors wanted her to use wasn’t working well. “I hated being on my back and having them hold my legs. I think I would have made quicker progress if I’d been allowed to stand or squat on the floor, or to have my legs pushing on something while I was sitting up. Finally the baby’s head did crown, and they were encouraging me to touch her, and Pat suggested the mirror so I could see her head coming out, which made me stronger.”

Noreen had said she wanted to check her baby’s gender for herself, “so I looked and found out, and I said, ‘Hello Erin Margaret Rose’ with the most wonder I’ve ever felt.”

She adds: “I knew I wanted other women who had had children around me during labour and birth, and just hearing my sister and doula say that things were going as they should helped me be confident.”

Gather support Midwife Karin Terpstra, who practises in Guelph, Ont., points out that, especially with a first baby, you don’t know how long the process will take, so all pregnant women should prepare for the possibility of a lengthy labour.

Her first suggestion is to arrange for extra labour support. That person can provide information and ideas about coping with pain, and be an extra pair of hands to massage tired muscles and apply pressure to the lower back to relieve the discomfort of back labour.

Pat Millar says: “All the other couples in our childbirth class hired the teacher, to provide labour support. I really regretted that we didn’t do that. In a long labour, that extra support is so crucial. Phil was more exhausted and scared than I was — I think because he didn’t have the hormones on his side. Another support person would have made a big difference.”

Terpstra agrees: “You need people who know what is going on and who know you and will support your choices. Some women like to have a lot of people around them — their mother, mother-in-law, sisters, friends. Others need perhaps just the partner and one other person. Hiring a doula may be a good option for many women. You might even feel different about this with each baby.”

Keep up your energy “Sleep or rest as much as you can in early labour,” advises Terpstra. A warm bath may help you relax, and Terpstra often tells the mothers she works with to try a glass of wine or some Gravol to induce sleepiness.

Eating is important in early labour too. “You want some easily digestible, nutritious food,” says Terpstra. “In more advanced labour, you probably won’t feel like eating. Sports drinks or sweetened herbal teas can help to give you some energy.”

If you are throwing up a lot during labour, intravenous fluids may be needed. Karine Clifton*, who laboured for nearly two days with her son Simon, says: “I threw up the whole time, even water, so I became very dehydrated.” Once she had an IV in place, she regained some energy.

Keep moving In early labour, rest is a priority, but as labour becomes active, staying in motion helps the contractions to be more effective.

“Don’t exhaust yourself,” Terpstra explains, “but go for a walk, climb the stairs, dance, sway or sit on a birthing ball. Keep changing your position. Listen to what your body is telling you — you might want to go on your hands and knees and rock back and forth, or do lunges to help shift a baby who is stuck in a posterior position.”

A long labour is sometimes the result of a baby who is not positioned well for being born, and moving around may help to shift the baby to where he should be. Research has shown that walking can be more effective in speeding up labour than augmenting with Pitocin.

Take your feelings into account Terpstra finds that sometimes the mother’s feelings can inhibit effective labour. She points out that farmers know that a stressful environment or the presence of strangers can stop an animal from giving birth, so it’s not surprising that women can be affected by their emotions as well.

Karine Clifton says: “I tell pregnant women to be careful who they have with them during labour. My son’s father and I had ended our relationship, but he wanted to be there for the birth. It was difficult and stressful for me, though, because he was not emotionally there for me and his presence affected my concentration.”

Often a labour that has been moving well at home will slow down when the mother arrives at the hospital, just because she’s now in a strange new environment. The opposite can also be true, Terpstra adds: A women who feels safer in the hospital may not progress as well at home. Just being aware that this may be a factor can help you deal with it. If your labour does slow down when you arrive at the hospital, try going for a walk or listening to music to help distract you.

“You may suddenly decide that you want your mother with you,” Terpstra says. “Or you may realize that having your children present is not working for you because they are too distracting. Acknowledge those feelings and make the changes you need to create the right environment for you.”

Customize your labour plans Every woman responds differently to pain, fear and stress. Do you like to relax by listening to music, going for a walk, having a massage or talking with friends? Keep these things in mind when you are preparing to give birth. Create a CD of music to listen to, or invite support people who know their role is to rub your back and say encouraging words to you.

“If your labour turns out to be short, and you don’t get to listen to all the music or do all the walking you had planned, that’s OK,” says Terpstra. “It’s better to be overprepared than not have what you need to cope.”

Part of being prepared includes gathering information about all the possibilities. Bordua notes: “Even if you are planning a home birth, know about the hospital’s policies and rules, and go on a tour.” Terpstra adds: “And if you are planning a hospital birth, learn about handling emergency deliveries at home because sometimes after a long drawn-out prelabour, the last part goes very quickly.”

Stay focused It’s easy in a long labour to forget the purpose of the whole thing. You feel exhausted and in pain, and that’s all you can think about. Bringing out some photos of your other children as newborns, or the baby sleepers you’ve bought for this new arrival, may help to keep your focus.

Of course, there’s nothing like the birth of your baby to remind you what this is all about. Like many mothers, Noreen Millar had a little trouble believing there was a real person waiting to be born — until she held her daughter in her arms. Her welcoming words to Erin might have struck a bystander as a bit funny, she recalls. “I just kept saying, I didn’t know you were in there!”

Facts about lengthy labours

How is a long labour defined? Guelph, Ont., midwife Karin Terpstra says it’s important to distinguish between prelabour (or prodromal labour) and active labour in evaluating how labour is progressing.

“The research is clear that prelabour can go on for days and it isn’t a problem,” she explains. “It can even stop altogether for a day or several days and start up again. Yes, those early contractions can feel pretty intense, and it can be frustrating to find out you’ve only dilated a couple of centimetres, but a long, slow, early labour is not a cause for concern.”

A long prelabour can happen naturally, but is especially common if labour is induced when the mother’s cervix is still thick and tightly closed. She may need to go through many hours — even days — of prelabour as her cervix gradually softens and gets ready to open.

Active labour, by Terpstra’s reckoning, begins when the mother is four centimetres dilated and is having strong, regular contractions.

“In this stage of labour, you want to see some steady progress, and there are some guidelines about the average rate of dilation,” she says. A 1996 study found that only five percent of mothers took more than 19.5 hours during active labour.

What is the outcome likely to be? “There is in fact a correlation between long labours and C-sections,” says Terpstra. “That doesn’t mean that a long labour will necessarily end up with a surgical birth.” Sisters Pat and Noreen Millar both had very lengthy labours lasting longer than a day, but still ended up with vaginal births.

How likely are you to have one? First babies typically take longer to emerge than later babies. A 2004 study found that overweight or obese women tended to have longer labours than those with a lower BMI (body mass index).

What causes them? • an inherited tendency (If your mother and sisters all had long labours, you are more likely to as well) • a baby whose position is less than ideal (such as a posterior position) • tension and stress (which may be caused by pain or by emotional factors) • the shape and structure of your pelvis, which may need additional time to open up for the baby

Non-medical ways to speed up labour • nipple stimulation (you can do this yourself, involve your partner or use an electric breast pump) • sex (if your membranes haven’t ruptured) • ask your caregiver about acupressure or herbal treatments to strengthen contractions

*name has been changed