In this continued series, we're rounding up and breaking down the top 10 fears of childbirth, all of which are addressed in a good childbirth class. Today, we're talking about fear number four (in no particular order), which is the fear of labor stalling or "petering out." Let's address this first by defining what "stalled labor" means.
A stalled labor refers to a period during labor after a good contraction pattern has been established (in other words, you are in "true" labor and your contractions are consistently growing longer, stronger, and closer together) when your contractions space out or stop altogether. This could be for a brief period (an hour or less) or for several hours. Let me also point out that a stall in labor is part of a normal labor and birth -- it's common and not a cause for panic or distress! The worry is, of course, that labor will quit and you will never give birth, or that labor will take too long and you will be forced to accept an intervention you didn't want, or that all of your hard work up to that point was for nothing -- that you're not really in labor after all!
Before we unpack those fears, let's talk about the common reasons for a stalled labor. A change in setting or a feeling of being uncomfortable or fearful of your environment is a big reason for a stalled labor. Why? Because birth hormones are powerful! As mammals, the hormones we produce in labor and birth are meant to protect us and our babies. So, if we sense danger or feel anxiety -- as in, the place we're in is not making us feel safe or comfortable -- hormones called catecholamines surge and can cause labor to stall until a sense of safety and peace is restored. Another form of this is something called "emotional dystocia," which simply means that mom is holding onto fears, concerns, or is being triggered from previous traumatic life events. This emotional pain and anxiety also can cause labor to stall. Having a good labor support team is crucial to helping the laboring person to release and work through these emotions, allowing labor to continue progressing.
Another common reason for labor to stall is baby's position. A baby who is not in an optimal position for birth (which is head down and facing up), can cause labor patterns to be erratic and even stall for a while. The good news is that there are many tricks and movements mom can do in labor to encourage baby to get into a better position and for labor to continue progressing.
Certain interventions, like an induction, epidural, and restricted movement also can cause a stalled labor. It's no secret that staying as mobile as possible (which can even be done with an epidural) will help keep labor progressing. It's also no secret that an induction (while sometimes medically necessary) is forcing your body to go into labor before it's physically ready. These factors, along with the use of epidural which can hinder a laboring person's ability to move and interrupt birth hormones, can impact the progress of labor.
Now, let's review specific fears of stalled labor.
I will never give birth! You will, in fact, give birth to your baby. It may take longer than you anticipated (which is the case for many women), but your labor will not stop indefinitely. To ease your worries, talk to your labor support team or care provider to provide suggestions to help get labor back on track (doulas are great for this).
Labor will be even longer. It's true that a stall in labor can make labor longer. But if you look at a stall in your labor as something that's part of the process -- or even necessary (to get baby in a better position, for example) -- you may be able to better accept it as part of your journey. You can try different things to get labor progressing again -- or you can take this time as a blessing in disguise and rest up for the rest of labor! Again, having a doula by your side can help reassure you that this is part of the process and encourage you to do what feels right and most helpful.
I might need a medical intervention. Sometimes, depending on the situation, a stalled labor can call for a medical intervention. But it's important not to rush to medical interventions too quickly (unless there's a reason to do so to protect mom and baby's health). The American Congress of Obstetricians and Gynecologists (ACOG) created revised guidelines to prevent a first cesarean, and state that a slow but steadily progressing labor is not cause for cesarean, nor is it cause for cesarean until the passing of six hours with few or non-effective contractions and no dilation. Pitocin often is the intervention of choice by care providers for a stalled labor. If Pitocin is suggested, you may want to consider alternative ways to progress labor. Pitocin, which is a synthetic form of the hormone oxytocin, produces stronger and more intense contractions, and carries risks. Talk to your labor support team or care provider about alternatives, like movement, nipple stimulation, time in the shower, or time alone. Also, if you're experiencing a stalled labor, you may want to ask to have the strength of your contractions measured to determine their effectiveness. This is done by inserting an internal uterine pressure monitor catheter (IUPC) into the opening of your cervix. While this can increase your risk of fever, it can also help you make an informed decision on the need for Pitocin.
I'm not really in labor! Generally, a stall in labor is talked about for women who are in active labor (dilated to 6cm or more). So yes, even with a stall, you are very likely in labor! Stalls in early labor and prelabor are very common, and may indicate that you have more time (hours or days) before active labor begins. Muster up patience, keep the faith, and look to your support team for encouragement.
Check out an earlier blog post to learn more about what to know if your labor stalls.