What does labor look like when the baby isn’t engaged?
- Early Labor goes on and on, or labor doesn’t even begin until after 41.5 to 42 weeks
- Irregular contractions do not get strong enough to go into active labor, though they can feel strong and occur over hours or days
- Contractions may also be very strong and grind on the pubic bone
- Dilation isn’t the predictive factor
- The baby’s little forehead may be felt resting on top of the pubic bone like a small ledge (pictured)
Scenarios with an unengaged head
Early labor can go on for a day or more, and sometimes the woman begins to think her starter is broken. This is because the labor can start and stop as the baby tries to get into the pelvic brim. Women may not dilate beyond 3 cm when the baby remains high. Labor can feel so strong as the uterus works hard to rotate the baby’s head to drop into the pelvis. These strong contractions can go on for days.
Once the baby engages, labor becomes much more effective and the baby is usually born in 8 hours or less. Other times, labor seems to begin and progress normally until a labor stall occurs in active labor. The baby remains high during the stall in this case. Not all unengaged labors have these characteristics, but these are quite common.
How to help the baby engage
You’d want to focus on engagement if the baby is at -2 or -3 station AND the labor didn’t progress within a few hours of regular contractions. You could also try the following techniques if the early labor felt strong but had a start and stop pattern (with strong contractions):
- Body Balancing with Jiggle; Side-lying Release; Forward-leaning Inversion; Ball squeeze (in Daily Activities)
- Posterior Pelvic Tilt through contractions
- Ten contractions in a row doing the Abdominal Lift and Tuck may be the most effective technique during contractions
- Sit on a firm birthing ball and do rather rapid hip circles or figure “8s,” especially if there are no contractions. Dip the hip is an alternative if no ball is available
- Open the pelvic brim with Walcher’s “Opening the Brim” Position. Note: This is only effective during contractions and not typically “fun,” so try abdominal lift with a posterior pelvic tilt first unless an epidural keeps you in bed. In the page for Walcher’s, you will find:
- Water Walcher’s
- Froggie Walcher’s
- Flying Cowgirl
Again, our goal is to help the baby rotate to the LOT, LOA, or OA fetal positions so the head fits more readily. We also want to help the baby tuck his chin with the abdominal lift and with circles on a birthing ball.
What will labor look like when the baby is finally engaged after this kind of start?
Once the baby engages, perhaps because the baby rotated and dropped into the pelvis, the labor often seems to stall. In this case, there is no problem as the uterus is simply resting. The mother can rest too, as long as her and her baby’s vital signs are good. Once the uterus is rested and the mother has eaten and slept, the labor will pick up again.
It won’t seem as painful when it starts up again, and the contractions will be more manageable this time around. The contractions will then get closer and longer lasting, and the cervix will open in response. Things will be more predictable when the baby’s chin is tucked and the head fits in the pelvis better.
Note: When the cervix is fully open and you find the baby is still high at the -3 station, your techniques to engage the baby may bring the baby all the way through the pelvis in a very short time. Be ready!
Why does labor seem to stop once the baby is engaged?
- Contractions change from being quite strong, long, close together, and painful to calmer with a strength that matches the current dilation.
- Labor may seem to stall if the uterus has already been working long and hard.
- Labor could pick up quickly, more easily, and with a lot of low pressure.
Problems after engagement (if the baby’s head position wasn’t optimal)
The baby can sometimes get stalled on another part of the pelvis. If the baby drops but the chin remains up, though the baby is coming down, the labor might still take a long time, depending on the pelvic shape.
We may then have to help open the mid-pelvis (ischial spines) and outlet. If the baby is at -1, 0, or +1 station, then the baby is engaged but stuck in the mid-pelvis. You should do a Side-lying Release followed by side lunges for either a Transverse Arrest or an Asynclitic baby.
The lunge is a wonderful technique for helping the baby when labor stalls at 0 station or below. If the baby drops but the head is tipped, as if the baby is listening to the outside world (in an asynclitic position), then the labor will remain long. Applying these techniques should help to open the mid-pelvis and allow the head to pass through.
Babies naturally engage in the pelvis when the birth anatomy is balanced. Contractions can help if the broad ligament is soft and the brim is open enough. Fetal chin tucking and coming down from the mother’s left side helps more babies fit into their mother’s inlets.
Generally, we hope for flexion and rotation before engagement. This is most important when we find the baby to be in the posterior position and high after 38 weeks. Dip the hip may be a good, specific technique to address this.
Work on balance before rotation and descent, even though sometimes we have a time issue, as when a woman’s membranes have released and her provider has a time limit for her labor. Descent from a non-optimal position may have additional challenges that may be met with maternal positioning and activities in labor. Doing balancing activities first will ease the approaching phase of active labor.