Thursday, January 14, 2010

Prodromal Labor, from a Doula’s Perspective

Rachel is a friend of mine through blogging. She is a doula in Alabama. Recently, she attended a prodromal birth. I asked if I could post her story—along with any thoughts she had as a doula on what may have been helpful or otherwise. Many women having prodromal labor make the same mistake: that of trying to get labor going early-on. This works fine if you go on to have an 8 hour labor, but there is no telling how long your labor will be, so take it from someone who just witnessed how things go when you choose that route: if you find yourself in early labor, don't get too excited or try to make things move along faster. (Especially if it is bedtime! Prodromal labor is notorious for kicking in at night.) Take labor as it comes. It will not leave you behind.

Here is Rachel's story:

I originally wrote this as a "facts only" birth story. But for those interested from learning from this experience I have added my opinions in blue.

(*I will make this a condensed version of this birth story*)

Amanda started ctx-ing a week before her due date. Thinking that it was time, she and Brian headed to the hotel. Yes, hotel. They live further out of town and were about a 45 minute drive from the hospital so they went to a fancy hotel about three minutes away from their hospital to ensure comfort as well as being able to wait until the last possible minute to head to the hospital. Really, really long story short. Amanda would get consistent, intense contractions for a few hours and then just stop. Oddly enough, once I would get to the hotel to check on her, she would putter out. Thankfully, she says it was because I made her too relaxed. ha. Good problem, I guess. (I had suggested to Amanda while she was still at home to try and lie down to see if the ctx's would stop, thus showing us if it was active labor or not. She was convinced that labor has to be "helped" along with constant movement, so she never laid down. Thus the frustration when she got to the hotel and I got her to lie down...they stopped. Please understand that real labor will continue whether or not you lie down or stand on your head.)

She did this for 44 hours. Off and on ctx's that were intense and longer than a minute, 3-5 minutes apart. When the last time that I went to check on her came around... (around 2 am) I went to the hotel and the ctx's were more intense and all we could judge, consistent. (Because they continued as she was in a side lying position for several hours). After about 4 hours mom was complaining of pressure and felt it was time to head to the hospital. (The ctx's were off and on longer than a minute, but that part wasn't consistent. I made the mistake of telling mom what we were looking for as our sign to head to hospital. Please note fellow doulas: do not tell a laboring mom what you are "looking for" when trying to determine her progress. The mind is a powerful thing and if you tell her you are waiting for her to feel pressure, her mind will tell her she is having pressure, no matter how slight the pressure is. I felt it was still too early to head to the hospital, but because she started complaining of pressure, we had to go to be on the safe side).

Once we got there she was 4cm, 80% effaced, -2 station. I had told her not to get discouraged no matter what we found out at the hospital, but it was hard not to, only because I agreed we should go because she said she had "pressure." But at -2, and water still intact, I'm not sure what pressure she was feeling. (Exactly why you don't tell the mom what you are looking for. It's not that mom wanted to head to the hospital that early, rather she just wants to believe it is going faster than it may be at that time. And for whatever reason, lots of moms believe that just being at the hospital will make it all "go faster." That is no guarantee.) Either way, anything we can do at the hotel, we can do at the hospital. Her doc was AMAZING and fully prepared to let her do whatever she wanted and even to leave her alone. Because mom was exhausted from 44 hours of prodromal and 4 hours of active labor, she needed some rest. However, Amanda is a eh hem… stubborn woman. ;-P (Again, we were constantly battling this false belief that you have to help a labor along. Nothing could be further from the truth. When dealing with a long labor you must REST. As in, get in a side lying position and get your full "break" in between contractions. But Amanda did not see the benefit in that and therefore wore herself out completely.)

After several hours of the same thing… (*again, condensing things*) It took another six hours to go one cm… and then another four hours to go one more cm. In that time, mom was giving up. She was exhausted. And I knew that without some rest, she would not make it to an unmedicated birth. After phoning a doula friend who suggested (thank you Virginia.. yes like a game show, "phone a friend") we get mom some narcotic (I would not recommend this for the average long birth. In this case I believe it was necessary only because mom refused to get rest on her own. It was for the purpose of slowing things down so that she could get some rest in between ctx's. This worked like a magic show... she rested for about an hour and a her ctx's slowed to more than 10 minutes apart. Once the meds wore off, she was renewed mentally and physically, enough to endure what would be the last two hours of her labor. However, the same thing could have been accomplished without the narcotics if she would have rested long before this point.)

After an hour of walking and pacing, she was checked and found to be at 6cm's. However, she felt discouraged and was ready for the epidural. (*I think it is important to note something here. After the birth was over, Brian informed me of something that I was clueless about. He and Amanda made an agreement before the labor ever started that if Amanda wanted the epidural at any point, he would support her. This is important to note because in my opinion if you are planning on that option at any point, you WILL get that epidural. It also would have changed whether I would have taken them as clients. Meaning, I would have been able to explain my philosophy on the issue and suggested that they consider NOT hiring a doula. This is an issue of philosophy of labor. Because the mind is a powerful thing, if you give your mind an "out" it will take that "out." I wholeheartedly believe, also, that her decision to put the epidural in play affected her labor. She never fully embraced her labor as what it would take to have her baby. I think because she never fully embraced what one friend calls, "labor-land," her body responded with a fight... taking 10 hours to go 2 cm's. Yes, I believe that is connected to her mental/emotional acceptance of "other options" with the epidural).

After much back and forth with the two of them, I conceded (*keep in mind, I knew nothing of their agreement, only that I had told them I would use every resource available to move away from an epidural because that is what they communicated to me that they wanted. I was done trying to convince them of something that we were all originally on the same page with, so I thought). The nurse was to call for the epi but the doc was stuck in a c-section and Amanda would have to wait. So as we are dealing with each ctx… she has a big one and then has a good amount of discharge on the floor during the ctx. At this point… we get her in the bed to get some narcotic until the epidural can be done. At that moment, her water breaks (on its own), she has her narcotic and immediately her ctx's hit 2 min apart, 90 seconds in length. I pull Brian aside and say, "I know she wants an epi… but I believe all of these things are pointing to transition and I think very quickly you are about to hold your baby. If you can let me get her through each ctx, one at a time, I believe this birth can happen the way you guys originally wanted it."

He agreed to work with me until the epi arrived. About 20 minutes later, Amanda shot up and yelled, "RING OF FIRE." Surprised, I said, "okay honey… are you just feeling pressure?" to which she looked at me like I was crazy and said, "NO… ring of fire." So I took a peek and baby's head was definitely crowning. About 10 minutes later, Amanda had her sweet baby girl.

No epidural. And even though they had their agreement… they both assured me that they were glad that I persisted like I did and that she "went all the way." (However, honestly, had I known about the agreement, I would not have persisted.) Later the next day she told me how wonderful she felt and how happy she was that it went the way it did.. except for the whole "length of labor thing." ha! I don't blame her. (But let me be clear. I define a natural birth as one that you embrace even if it is long, and you do what your body needs. You have to be mentally prepared that things don't always go the way you expect them to or that they will be anything like they were in your other births. If you are trying to do things based on misinformation and not taking the advice of your doula, you may want to reconsider why you want a 'natural birth' to begin with. Otherwise, it may just mean that you want an unmedicated birth but not a natural one.).


  1. Nice story, very informative.

  2. Thanks for your comments. I'm just starting the requirements to be certified as a birth doula, so I really appreciate it.

    I've only experienced one labor, but I also really feel that your mental and emotional state can greatly affect labor. I remember thinking that I "should" be upright during my (short) labor, but laying down just felt better, and so that's what I did. Some moms need to be upright, and some don't; I know that now!

  3. I appreciate this story, I learned quite a few things!
    I've also noticed that whenever couples say "we're going to try for all natural for as long as possible, but if it gets really bad we'll get the epi"
    They always end up getting the epidural!
    I'm planning an unmedicated birth for my first child. I'll be giving birth in a midwife led birthing centre, so even if at one point I'm screaming for that epidural, it's impossible for me to get one since its not available at that centre!