It's amazing to see how much a baby 's head, hand, or even neck can make labor so vastly different, harder, longer, and more difficult. So many times, I have heard of women who have "week" long labors or "all back" labors and midwives who participate in them in their hands-off practice. For a while now, I have been so frustrated with the mentality that long labors are normal and good. Even more so, I have been more frustrated with myself because I agree with labor being natural and not rushing the process, but the long part bothers me.I want to feel that a woman should have all the time she needs to deliver, but in my heart, it doesn't feel right. Let me explain:
Three and a half years ago. Melody and I had a client who took it upon herself to take castor oil without telling us. She told us after the fact when she was having contractions every five minutes. She started the conversation with "I have a story to tell you" and proceeded to tell us how she took castor oil in the afternoon and was having these "cramps" every few minutes. We felt it necessary to go check on her. When we arrived she was six centimeters and her water broke. Oddly enough after her water broke, her contractions spaced out to being irregular. She did this for another 18 more hours. I could not figure out how in eighteen hours, there was no longer progression! 18 hours at 6 centimeters! Some would say, "well, it's her first baby. she will do it." " It's her first baby: first babies take a long time." Melody really didn't want to intervene, but I couldn't take it anymore. Something was not right. But of course, she and I had been wanting to be more "hands-off" in our practice since we came from a more pro-active background and being labeled as such. We wanted to do let the body do it's thing. Finally, Melody checked and this baby was persistently OP (occiput posterior) or face-up. I am sure that I can be ridiculed easily for being a midwife and having such nasty thoughts such as "long labors can't be normal" and maybe even thinking that there's gotta be another way! Well, there is!
Honestly, Melody and I were struggling to agree on this labor...she desiring to let things be and I wanting to help it along and do something. Now I know that there is this thing about hiring a midwife and wanting her to be a guide...and wanting a "hands-off" birth, but you are also hired as a healthcare provider and you stil have a job to do. So rather than COMPLETELY laying off, I believe there are some signposts to intervening. Melody finally got online and discovered Spinning Babies : http://www.spinningbabies.com/ . At the time there was an excercise we found what I now call "The Roll" , where the woman switches positions in labor and in certain time to help baby get back in the correct and perfect position. Imagine that, taking control of the situation to avoid transport for failure to progress or maternal exhaustion. I don't want to sound threatening, but I got very tired very quickly with seeing Mama's labor longer than they had to; so we found another midwife who has a solution! I firmly believe that malpresentation is a big reason that women "fail to progress" and/or have week long prodromal labors and these postional excercises have done wonders!
For example, with our above client: we went to her and said okay time to work and get this baby out...she was very okay with this being ruptured for 18+ hours and having annoying contractions. So we did the "Rebozo", then the suggested roll from Gail Tulley , then Mama stood up and said OOOOOOOWWWWWWW .....90 minutes later, she was holding her son. Yes, being at 6 cms for 18+ hours, she went from 6 to complete and baby out (first time mom) in 90 minutes!! Time and time again, I have used the rebozo and "the roll" and had women either kick into labor and/or progress quickly.
Now, how can you tell what position the baby is in? Well, it's not just by palpation. The baby's back can be on the left and right side and still have the head be posterior or even ascynclitic. But so how can you tell? Well, unfortunately mainly by doing an internal exam. I know that so many women and their midwives don't really believe in it or prefer not to do many if any at all; but I have found that 1-4 minutes of discomfort can save a woman from being transported or even several hours added to her labor. Now,I am not trying to be an interventive midwife, I am trying to be a midwife that feels birth is sacred and beautiful so I will do what it takes from it turning into a traumatizing experience.
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