(Contractions are irregular and last roughly 20-40 seconds, but are inconsistent.)
When the baby isn’t fitting well, these contractions can be 60-120 seconds with no dilation. One sign can be that the labor pattern is erratic, but just don’t make an assumption. It can be difficult to tell this situation from a transition without a vaginal exam. See Comparing OA and OP Labor Patterns for more details.
In this phase, the following things can really help:
- Relax the abdomen with Rebozo sifting.
- Sit smart, with your back straight or a little forward to help the baby settle in the front of your abdomen.
- Abdominal and sacral releases
- Acupressure and acupuncture
- Chiropractic adjustment
- Warm chamomile tea
- Plenty of laughter and love!
Try and go about your day as normally as you can. Take a nap (but don’t forget to Rest Smart).
Is your abdominal wall loose? Does your uterus hang forward and make a crease underneath at the front of your panty line? Then use a pregnancy belt or a Rebozo to lift your uterus and allow the baby to come down on your cervix. Wear it until the baby is out to prevent a stall in labor after the head is born. Check-in with your provider(s) if any special needs present themselves.
(Contractions are regular and last 20-45 seconds with a frequency of 4-10 minutes apart. Things may begin to get bloody at this stage, which is normal.)
In this early stage, the following tips can help:
- Relax the abdomen with the same things listed above in Pre-Labor.
- Maintain your regular daily routine. (Take into special consideration if your water broke.)
- Eat every two hours and drink lots of water, electrolyte drinks, and/or a little grape juice or hibiscus tea (for example) every hour.
- Rest Smart when you’re tired.
- Get up and walk or slow dance. Get down on your hands and knees and “wash the floor.”
- Use gravity to your advantage with the Abdominal Lift.
- Kneel over the back of a couch or hospital bed. Or, kneel on pillows and rest your arms in a comfy chair.
- Try some lively hula-hoop circles on the Birth Ball for 20 minutes.
- Stand and lean forward in the shower if sitting is too painful. Do some pelvic circles while standing.
- Check-in with your provider(s) to let them know your potential for labor. If you have a doula, call them! Doula-supported labors are statistically proven to be shorter than labors without one.
Active Labor I
(Beginning around 4 cm dilation. Contractions last 60-75 seconds with a frequency of 3-6 minutes apart.)
In this phase, the following advice can help:
- You may want quiet, dark privacy.
- Continue to Rest Smart when tired and use the relaxation methods above. Massage between contractions as well.
- Do more Rebozo sifting for serious relaxation.
- Walking can help contractions continue to come.
- Be sure to eat!
- Do more circles on the birth ball.
- Continue to lunge for one-sided pain.
- Try an inversion of one type or another (your preference).
- Then, do the Trochanter Roll (Walcher’s Maneuver) if the baby isn’t in the brim before now.
Are you confined to bed?
Some providers persuade or direct all their moms to stay in bed during labor. Sometimes a woman’s health is such that she has to stay in bed.
If this is the case, try the following techniques to help:
- Keep rotating the pelvis.
- Lay on your left side with a pillow between your knees, or lift your right knee high up on a stack of pillows and shift your left hip back behind you so your belly aims into the mattress. Use pillows to support what needs support. Switch to your right side and try each of the different variations.
- If you can kneel and lean over a birthing ball or the raised head of the bed, do so for 30 minutes between sides. Change positions every 30 minutes.
- If your labor starts progressing rapidly, don’t worry too much about position changes for the purpose of labor progress. If labor doesn’t continue to progress, try to keep your back straight, not curled.
Active Labor II
(Beginning around 5 cm dilation. Contractions last 60-85 seconds with a frequency of 3-5 minutes apart.)
If you can cope through 5 cm, you’re likely to have a natural birth! Continue to follow these tips:
- Relax your involuntary muscles as described before. Or, if you have a loose, pendulous womb, wear a pregnancy belt during your entire labor.
- Rest Smart℠ when tired.
- At any time during active labor (through the next three described phases), you can:
- Afterward, you will probably want to sink in a full tub or take a warm shower to mentally relax after those three techniques, which can be rather challenging this far into labor, but amazingly effective.
- Abdominal lift and tuck as before to take advantage of gravity. Do this for 10 contractions in a row, resting in between.
- Lunge for 6 contractions on each side. I like to do 3 contractions on one side, then switch knees and repeat, rather than all 6 on one side.
- Stand and hang onto your partner’s neck, or onto a sheet thrown over the bathroom door. (Tie a knot in one end and throw the knot over the door, then shut the door with the knot on the other side. Now the sheet won’t slip off the door and you can hang on and bend your knees and move to the contractions.)
- Lift one hip and put one foot up. For instance, when sitting on the toilet, put one foot on a stool (or anything of a similar height) for three contractions. Stand for one with your other foot up on something. Then sit for three, stand for one, and repeat.
- Slow dance or slow dance in the shower while your partner sprays your back with a warm stream of water from the shower hose.
Active Labor III
(Dilation has advanced to 6-8 cm. Contractions last 60-85 seconds with a frequency of 3-4 minutes apart.)
If you’re not at your birth site yet, now is a good time to go! Once there, continue to follow these tips:
- Balance as before, then relax the throat by “cooing.” Deep, low tones are usually better than high-pitched ones.
- Lots of moms like to be low to the ground, as they feel grounded with their knees deeply bent. Try kneeling on the floor while leaning forward, for example.
- Need to speed things up? Sit on a toilet for three contractions, then stand for three, and then sit for three again.
- Birth balls are rarely desired this late in labor, but if you’re up for it, give it a try.
- Lunge if you haven’t before, or try again for three contractions on each side and repeat.
- Walking can still be helpful, but may not be practical.
- Put one foot up on something when standing. Have your knee out diagonally and a foot on a stool (or other item).
- You will know what you need as your body feels progress. If you feel lost or frustrated, return to a calm state and do a Side-lying Release on both sides, followed by shake the apple tree.
- Make the pelvis open on one side by putting one foot on a stool. (Or, anything else you happen to have handy!)
Active Labor IV
(Dilation increases to 8-10 cm. Contractions last 75-120 seconds with a frequency of 2.5-4 minutes apart. Likely to be plenty of blood present now.)
In this stage, the following tips can help:
- Continue balancing as before. Inversions are a common success for the stall in posterior labor.
- Use of a doula or face-to-face support is commonly appreciated.
- Loud moaning to a rhythm and a cool cloth can also help.
- Stand and lean forward to utilize gravity.
- Continue to Rest Smart℠ when in bed.
- Stand and hang on to the Rebozo or give a squat bar a try through 3-6 contractions.
- Lunge, holding a Rebozo or a sheet and straightening the back. Bend your knees with contractions and move freely.
- Is the baby still too high? Try another Trochanter Roll with Walcher’s Maneuver.
- Follow that up with a side-lying pelvic floor release.
Pushing or Releasing
(The second stage has begun. Contractions are now 45-75 seconds long with a frequency of 3-5 minutes.)
In this final stage, the following advice can help:
- Be upright, with your back long and extended—don’t curl your back! When labor is not progressing readily, let your back be straight the way it naturally wants to lengthen.
- Sit up on a toilet (the porcelain birthing stool), lay on your side with your back arched instinctually, or stand and lift your arms to hang onto something sturdy above you.
- Relax as best you can in between contractions. Let the contraction get started before pushing voluntarily. If you need to push, use exhale pushing to conserve your strength and mental stamina. At the end of each contraction, take several deep cleansing breaths. Smile and feel the joy.
- Make deep vocalizations, vowel sounds, or roaring as desired.
- Kiss your partner.
- Know that your baby is helping you by pressing that pain out of your body. Work as a team. Let the baby rock back and forth in your pelvis. This relaxes the tissues in the perineum.
- Use vertical positions or side-lying on the bed to open the pelvis.
- Do some “towel pull” squats for 3-6 contractions.
- Use a hot washcloth on the perineum, and a cold, wet washcloth on the anus to prevent or soothe hemorrhoids.
- Rock forward and back while kneeling and leaning over a birth ball or the raised head of the bed.
- Keep lunging if the baby is asynclitic.