“Doctors Urge Patience, and Longer Labor to Reduce C-Section,” appeared on my Facebook feed last night. I read it and felt this bubbling up inside me of joy and hope. There it was in the mainstream media, a thing that midwives, doulas and childbirth educators have been saying forever. Labor takes time, pushing takes time and labor can be very long and still be normal.
In childbirth class last Monday we watch a video on birth by cesarean. The story follows a mom who appears in the first frames in triage, gowned and smiling for the camera, displaying her large belly. She tells the camera she arrived at the hospital when her contractions were five minutes apart, spent an hour in triage and was finally admitted to labor and delivery. As the story unfolds she receives an early epidural, pitocin, spikes a fever and her labor “stalls” at five centimeters. At this point her doctors suggest a c-section which she consents to. After the video I ask the class if they notice anything about this labor that the mom could have done different to improve her chances for a vaginal birth. One couple offers “stay home longer, don’t go to the hospital too soon.” Another couple looks at me and says, “but she said her contractions were five minutes apart.” Yes, I nod and look back at my class. They have all been told by their physicians that they are to come to the hospital when their contractions are five minutes apart, are one minute long and have been that way for an hour. But the mom in this video is casually standing in triage, smiling for the camera. We review the emotional signposts of labor and talk about how they can be different for each mom. Some moms will be deep into active labor and need to go to the hospital when contractions have been five minutes apart for an hour, and some moms might have contractions five minutes apart for many hours and still be laughing, talking and in early labor. I urge them all to discuss their plans and wishes for labor with their doctors and discuss if there might be different parameters based on what their plan is for pain management. I believe that changes in obstetrics come through two channels, science and consumer demand. We now have the science that shows that length of labor and pushing is much longer than we used to believe was normal, now we need to change the policies that put women in the hospital too early and lead to an increase in interventions.
When I was pregnant with my first child my midwives told me to call them when my contractions were longer, stronger and closer together, regardless of the timing. They wanted to know when I made that emotional shift into the laboring mind, when smiling or talking through contractions was too hard, and all of my focus was turned inward. This, they told me, was active labor.