When Labor Stalls: Common Causes and What You Can Do
While there are certain universal markers for the different stages of labor, not all women experience labor in the same way or at the same pace. When a woman is in active labor and her labor slows down or stops, it is referred to as "stalled labor." Reasons for the stall can include a slowing down of contractions, contractions without dilation, or the baby not descending, despite contractions still occurring.
A stalled labor can feel distressing and discouraging, but the good news is that it usually does not pose any danger, and it can often be resolved.
What Stalled Labor Means to Doctors
In the hospital, many caregivers view stalled labor as something that needs to be "corrected" with interventions such as administering the drug Pitocin, artificially breaking the bag of water, or even cesarean. Labor may be considered "stalled" because caregivers compare it to "normal" labor as dictated by "Friedman's Curve."
(In 1955, Emanuel Friedman, an American obstetrician, developed a set of data that was used to predict the speed at which a woman would dilate in labor. He found that a woman should dilate 1cm per hour once she is in active labor. Despite evidence that this practice is outdated, many care providers still use this incorrect information as a guideline.)
What Stalled Labor Means for You
The best way to avoid getting shuttled into the labor-Pitocin-cesarean trap where stalled labor can often lead is to know your stuff: Learn about the common causes of labor, things you can do to get labor back on track, and the best questions to ask when your doctor or midwife suggests an intervention due to suspected stalled labor.
Common Causes of Stalled Labor
Induction: Induction carries risks, one of the most common being that the induction will not "work," ending in a cesarean rather than a vaginal birth. When you are induced, your body is artificially forced into labor, likely before you and your baby are ready. This can lead to a stalled labor, more interventions to speed up your labor, and then a possible cesarean section.
If your doctor suggests an induction, find out why, and whether or not it's for a true medical reason. Ask about your Bishop's Score, which is an assessment of how ready your cervix is for induction. The higher your Bishop's Score, the more likely your induction will be successful (you will go into labor). If your Bishop Score is low and you and your baby are healthy, tell your care provider you would like to go into labor on your own. If your doctor or midwife presses for an induction, ask about the risk of waiting to induce until your cervix is more favorable.
Epidural: Some studies have shown that an epidural can slow down the pushing phase of labor, and while data is inconclusive on its effect on active labor and transition, many women report that their contractions weakened and spaced out after receiving an epidural, often leading to the use of Pitocin to get it going again. This could be attributed to the restriction on a woman's ability to move and change positions, or it could be due to the fact that an epidural relaxes the uterine and pelvic floor muscles.
Emotional Stress: Underlying emotional or psychological stress can cause labor to stall or slow down. Also known as "emotional dystocia," this can be anything from an extreme fear of labor pain, not feeling safe, or lack of privacy, to trauma from prior sexual abuse.
If you have any underlying issues you think could impact labor, notify your birth team (partner, doula, doctor, midwife, nurse). They will help you to deal with the emotions coming up during your labor, reassure you of your safety, and support you during the process.
Baby's Position: How your baby is positioned for labor can affect the length of your labor. A baby is considered "malpositioned" for birth when she is not positioned facing your back or left side. Correcting the baby's position could mean an easier, quicker labor. If you or your care providers suspect that your baby's position is causing issues with your labor, walking and changing positions can help correct this.
5 Things You Can Do When Labor Stalls
If labor stalls, take heart in knowing that it's most likely temporary. If your care provider recommends Pitocin to get your labor going again, find out if it's necessary. You can ask: Is my baby healthy? Am I healthy? What are the risks in continuing to labor without Pitocin? If you and baby are healthy, you should be free to continue laboring without Pitocin. If your care provider recommends a cesarean, repeat the same questioning. If you and your baby are not in immediate danger but your care provider still recommends a cesarean, consider asking for more time. You can use that time to try some of the following techniques to jumpstart a stalled labor.
1. Rest: If you can manage to rest and if you are not being pressured to get labor going again, take advantage of the time. Labor is hard work and any opportunity you can take to rest will help your body recharge for the rest of your labor and birth.
2. Walk and Change Position: Walking and/or changing your position while in labor can work wonders for progression. Gravity and bodily movements can help baby descend and get into a more optimal position for birth. Sometimes, a few good squats are all it takes to cross the threshold of a stalled labor. If you're lying down, get upright. If you're sitting on a birth ball, try standing, squatting, or walking around. If you're experiencing back labor, try stair walking or side lunges. If you are laboring with an epidural, you can still use movement and position changes to help your labor progress. Author and childbirth expert Penny Simkin, PT, developed the "Rollover" movements for an epidural, which is demonstrated beautifully at SpinningBabies.com.
3. Consider Nipple Stimulation: Nipple stimulation (by way of rolling your nipples between your thumb and pointer finger or rubbing your nipples with your palm) is a very effective tool for bringing on longer and stronger contractions. Before you begin, be sure you know how long and how often to use nipple stimulation. Your doula or nurse may also be able to provide you with more information on this practice.
4. Change Your Environment: Sometimes, your environment (especially in the hospital) can cause a mental or emotional block that's stalling labor. Are the lights too harsh? Is the presence of your mother-in-law disturbing you? Do you want your partner to turn off the television? Are there too many nurses coming in and out? Environmental stimulus can impact the progress of labor. Dimming the lights, asking for some privacy, turning on music, and spraying lavender oil are just some of the ways you can change your environment and enter a more relaxed state.
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5. Shower It may take some convincing, but getting into a shower during labor can help you relax and may help intensify contractions. The water and heat release feel-good endorphins, and when you face the water, the stimulation on your nipples releases oxytocin, the hormone responsible for contractions.
Your best defense in working through or possibly avoiding a stalled labor lies in your choice of care provider. Choosing a doctor or midwife who has a low induction and cesarean rate, and who is comfortable with the variances of progression in a normal labor will increase your chances of a safe, healthy, and positive birth experience.