A doula writes, "need suggestions for what to do to get a labor going...she has been ruptured for over 24 hours and not really contracting and wanting to avoid pit...."

Sometimes labor seems late to start because the baby isn't able to enter the pelvis. Usually the first baby will engage about two weeks before the due date. Many of the occiput posterior babies don't engage before labor starts. Some do, of course. When the baby hasn't engaged and the due date has come and gone, I've almost always found the baby to be in the posterior position. When labor does start, contractions can be strong without much dilation and the baby remains high in the pelvis. Before the cervix opens well, we need to help baby come down into the pelvis well.

The first thing to do in labor are activities that help your body come into better balance.  Particularly your womb. This will help labor to progress.

Active labor movements help and will be enough for most women. Some women will need more help for a natural labor. 

The art of the long labor involves helping a mother keep up her morale while addressing her body's needs for such marathon activity. We can sooth the mother, especially helping her ease her back pain when we can. But it is important to address the reason for the long labor when we can. When the issue is in the tissue there is something we can do. Tight muscles, tight ligaments -these can be relaxed with body work and even by things the mother can do herself, or with the help of people at her birth. There are four specific techniques that are amazing. 

There are differences seen in the labor pattern of an anterior baby and that of the posterior baby. These signals may help you determine whether a baby is in the occipital posterior position. These signals may also show up in labors where the baby has to get symmetrical for labor to progress, whether or not the long labor is caused by a posterior position.

Labor Progress Tips with the Three Principles of Spinning Babies©

Find what to do when in this list of labor activities for each phase and stage of labor.