The cardinal movements of labor are the rotations of the baby as he moves through the pelvis. During labor, the baby must make specific rotations so that the widest diameters of his head and shoulders will match the widest diameter of the pelvis. The uterine contractions move the baby down the pelvis as he follows the path of least resistance. When the baby enters the pelvis, his head faces sideways in the pelvis. As he moves down the pelvis during labor, his head turns so that by the time you are ready to push, he is looking at your back. This also places his shoulders in correct alignment to enter the pelvis. After the baby’s head is delivered, his head rotates again to look at your thigh so that his shoulders are lined up to come under the pubic bone.
Even though all labors are different, the majority of labors follow somewhat of a pattern. However, four types of labor that vary significantly from the “norm” are preterm labor, precipitate labor, prolonged labor, and back labor.
A preterm labor is a labor that begins before 37 weeks gestation. Preterm labor is a concern because babies born prior to 37 weeks may not be mature and may require intensive nursing care to survive. Your physician will attempt to stop preterm labor. This may be accomplished by bed rest, home monitoring, medication, or hospitalization. For a complete discussion of this labor variation, see “Preterm Labor”
A precipitate labor is a labor that lasts 3 hours or less. This short duration may sound appealing, but it presents its own special problems. The contractions in a precipitate labor are usually quite intense and may be misinterpreted as a very difficult early labor. Because the contractions may be hard to control, the labor partner should remain with the woman at all times and use all the comfort measures at his disposal. If left alone, the woman may experience confusion and fear because of lack of knowledge about her labor’s progress. These feelings can be complicated by the rushing around of the hospital staff upon discovery of the labor’s advanced state.
If you suspect you are having a precipitate labor, you must trust your own feelings about your body. Be sure to request a vaginal examination as soon as you are admitted to the hospital to determine your progress. Your own control and the directions of a good labor partner are crucial. You will need to concentrate on relaxing, even though it may be difficult. In addition, before requesting medication, begin using comfort measures and try accelerated-decelerated breathing, along with changing your position and emptying your bladder. Your labor is almost over!
In some cases, labor progresses so rapidly that the woman does not have enough time to get to the hospital.
A prolonged labor is a labor that lasts 24 hours or more. Some of the causes of this type of labor are ineffective contractions, breech presentation, posteri- or position, large size of baby, small pelvis, extreme tension, large amounts of medication, early administration of an epidural, fasting during labor, and malnutrition during pregnancy.
Considerable patience is required during a long labor, along with creativity in the use of breathing techniques, comfort measures, and relaxation. Fatigue is difficult to combat, and dozing between contractions may make it even harder to be ready for the next contraction. If you experience a prolonged labor, you and your partner must work together, using all the techniques and comfort measures you can to avoid discouragement, tension, and fatigue. Encouragement is essential. You need to relax as much as possible to conserve your energy. Labor in a tub of warm water if you become fatigued and are tense. Walking often helps to speed up labor. If you have been confined to bed, ask to be allowed to walk around. Also, stimulating your nipples will release oxytocin into your system and may help to strengthen the contractions.
During a prolonged labor, the fetus’s condition must be monitored carefully by a nurse or a fetal heart monitor. You will probably receive IV fluids for nourishment and to prevent dehydration if you have not been allowed to eat or drink. Pitocin is usually administered to increase the strength of the contractions.
When a woman has a history of sexual abuse, her labor can be adversely affected. Her emotions can release stress hormones that may slow and alter her labor. It is important that her caregiver be aware of the history and also be familiar with the phrases or words that trigger the memory. These are usually the same words that her attacker used during the abuse. Some of these phrases may be commonly used during childbirth. Certain touches may also be upsetting. During the second stage, the woman may experience difficulty in pushing or may even refuse to bear down. A woman with this type of history will need to be shown patience and understanding during her labor. A female support person or caregiver may be beneficial.
If your labor is prolonged or extremely difficult, make sure that you understand your situation—what is happening to you, suggested procedures, and diagnosis. If you have questions, ask your caregiver. And remember, labor is not an endurance contest. If you become too fatigued and can no longer cope with the more powerful Pitocin-augmented contractions, consider medication or an epidural.
A back labor is a labor that is felt primarily in the back or hips, producing extreme discomfort during and often between contractions. About one out of four women experiences back labor to some degree. Back labor is usually caused by a posterior position of the baby, but can also be caused by a breech presentation, tension, variations in anatomy, or laboring on the back.
Because discomfort is also felt between contractions, rest and relaxation are more difficult to achieve with a back labor. In addition, foe labor may last longer. If you have a back labor, take the contractions one at a time and experiment with the following comfort measures.
Get the baby off your back. Do not lie or sit in any position that places the weight of the baby on your spine. Get into a position that will encourage the baby to rotate. The most effective positions are ones in which you are upright because they give you the advantage of gravity. You can walk between contractions, and when a contraction begins, use your partner or the back of a chair for support and sway your hips as if dancing, Perform the lunge, or have your partner do the double hip squeeze. (For instructions on how to do the double hip squeeze, see “Counterpressure”.) Get into the shower and have your partner direct the spray at your lower back.
You may want to try sitting backwards and straddling a chair, using pillows for support. Or, sit forward on the edge of the chair and lean against your partner, kneeling in front of you, for support. If you are in bed, sit on the side of the bed, put your feet on a chair, and lean on the over-the-bed table or a pillow positioned on your lap.
Several kneeling positions are very comfortable. Try the pelvic rock on all fours. You can also try kneeling on the floor, using the seat of a chair as your upper-body support. If you are in bed, kneel on all fours, kneel against the raised head of the bed, or kneel with your upper body elevated on pillows.
Side-lying while in bed or in a tub may be a comfortable position. If in bed, make sure that you are well supported by pillows under your head, uterus, and upper leg. You may want to try changing position from side-lying to kneeling on all fours to side-lying on the opposite side. Repeat this sequence, remaining in each position for 15 minutes.
Another position that may be uncomfortable for the baby and encourage his rotation is to lie on your back with a rolled-up blanket tucked beneath the small of your back to increase the angle of your spine. Alternate this position with side-lying every 15 minutes. If your baby does not rotate, however, and is still posterior when you begin pushing, you can also push in this position to encourage rotation. Your partner can hold up your legs, or you can bend your knees slightly and rest your heels on the bed. Gnce tire baby has rotated, you can continue pushing in a more comfortable position.
The best position for pushing if your baby is in the posterior position is the squat. This position increases your pelvic capacity by as much as 30 percent. You can also try the dangle position. To get into the dangle, have the nurse remove the bottom third of the birthing bed and insert tire foot rests. Your partner can sit on the edge of the bed with his feet on the foot rests. Then stand between your partner’s legs with your back toward your partner. During the contraction, rest your forearms on your partner’s thighs, bend your knees, and perform a partial squat. Other pushing positions that you may want to try if your baby continues to be posterior are side-lying and kneeling. A variation of the kneeling position places one knee on the bed and the sole of the other foot on the bed. During the contraction, you can lunge in this position to expand the pelvis.
In addition to changing position frequently, many women want their partner to perform counterpressure or acupressure. Several methods have been used with success. Try having your partner press the heel of his hand or his fist against the area of greatest discomfort, using as much force as is comforting to you. Your partner can also kneel on the bed with one knee pressed against your lower back as you lie on your side.
Or, try lying on your own fists or on a roll of toilet tissue or several tennis balls tied in a sock. These last suggestions can be especially helpful during vaginal exams, when you may need to be on your back. Having your partner massage your lower back with lotion or oil may also be effective.
You may find it comforting to have your partner apply warm or cold compresses to your back. While at home, you can use a hot water bottle. In the hospital, you can soak washcloths in hot water and apply them. Try laboring in a warm tub or shower. You can make cold compresses from ice packs, “blue ice,” or frozen juice cans wrapped in towels. In addition, try a Tupperware rolling pin filled with cold water or crushed ice, or washcloths soaked in ice water.
Other measures that might help include slow, deep breathing between contractions, which promotes relaxation, and touch relaxation. Or, move on to the more advanced breathing techniques sooner than you planned. Finally, an encouraging and supportive labor partner is the best tool for handling this kind of labor.