A few blogs back, I wrote about the importance of listening to labor patterns, but I also felt the need to give a tangible map now that we have recognized that the labor pattern is talking to us as far as what we might do next.  Validation that the labor patterns provide information of physiological needs is important.  But now what do we do with that information?

Everyone at Term (in or out of labor):

Nourishment:

Have they been eating and drinking?  If not, this is the first pillar for physiology.  Especially if we are having irregular contractions or contractions that are painful without progress, let’s start with the food of life and the water of life as we move towards restorative actions.

Fear and Birth:

Within physiological pauses mentioned below, I don’t address the fear factor.  Fear can interrupt the hormonal cycle of contractions as it can wipe out oxytocin release until safety is achieved. When a person feels safe, there is more space for descent.  This senses of safety allows for optimal hormonal interaction as baby comes down lower.  How do we address the underlying causes for fear in an acute moment in labor?  We validate them.  Hold them.  Bring things forth.  Love them.  Yes, it is scary.  It is true sometimes we aren’t in control.  So much can come up including somatic release of abuse history or abandonment or our own birth or previous trauma.  We cannot be the experts of this moment but we can hold space and recognize what works for the birthgiver to feel safer from one moment to the next.  We respect the space and we stay true to our word.  This is a potential healing space.

Term Pregnancy (“Am I in labor yet?”):

1. Has the Birthgiver given birth before?  If yes, this might be an installment program leading to a bit of work here and there until labor starts (which can sometimes then go quickly).  In this case there may not be anything to do but offer support measures until labor. Sometimes we can add some magnesium to evening routines, exercise in the daytime, or 20 drops valerian to calm the monkey mind down enough to sleep.  Body balancing can also be useful along with supporting a pendulous belly with a binder so that the baby can be angled down into the pelvis. 
2. Is this a first baby?  We may spend extra time with body balancing with an on and off labor pattern.  We can address fascial patterning, muscles and ligaments, movement and the angle or flexion of the baby. If there is on and off early labor patterns, these contractions may be golden opportunities to utilize the power of the body and maternal positioning to help engage a baby.  Many positions won’t help the baby engage without the power behind it.  How do we know the difference between being in labor or not being in labor?  We may not know until retrospect.  This is one reason it cannot hurt to do some positioning work when there are more intense contractions with an on and off again labor pattern and even if the baby is overlapping the pubic bone. For more ideas of positions for engagement that have to have contractions go to https://www.spinningbabies.com/pregnancy-birth/labor/engaging-baby-in-labor/

In Labor:

1. Returning to the first time Birthgiver who has crazy hard labor followed by nothing happening or irregular pattern.  The uterus is trying to align and use force to engage the baby.  When it doesn’t occur, the uterus decides to take a break and see if backing off can be not just a time for rejuvenation but possibly enough time for baby to reposition and try again.  This is usually the time period that the Birthgiver can get frustrated or overwhelmed with pain and yet still be only 2-3 cm (and -3 station) .  Without the baby engaged or descending to put pressure on the cervix, the optimal hormones for pain coping cycles are not being released as well (Fergusson Reflex).  Certain positions that assist with engagement need contractions.  These contractions are “Golden Opportunities.” (See #2 above). This might also occur with a subsequent birth with a much larger baby than previous.
2. Also some labor contractions as baby descends can seem to “couple.”  The hypothesis of coupling (one larger contraction followed by a smaller contraction) is that there is a twist in the uterus that limits its efficiency.  The top of the uterus, according the Russian OB Savitsky, is like a hydraulic system pushing down on the baby.  As the rhythmic pulsations hit the ring between the upper and lower uterine segments, it can then take a turn to contract the lower uterine segment.  The second less intense contraction would then be that delayed action of the lower uterine segment.  This is a time to employ the Forward Leaning Inversion, Side Lying Release, Jiggling techniques and more as described in Spinning Babies®. 
3. After a baby is able to engage when it was a challenge, the uterus might need some time to regroup.  Spinning Babies® calls this a Rest and Restore time period. This time period should be celebrated with naps and food and continued support. 
4. Contractions can also slow after the baby has continued descent through the mid-pelvis into the outlet.  After such shifts, contractions might pause before pushing.  Many midwives will relish at that pregnant pause before spontaneous pushing.  The uterus is regrouping.    
5. Sometimes when babies are low and spontaneous pushing hasn’t occurred or has been denied (sometimes trauma arises in the moment), the uterus will slow down and take a break.  Some see this as a missed window of opportunity.  Others may see this as just a pause.