The Myth of "Early Labor"

Expecting Mother By Petercantfail at en.wikipedia [Public domain], from Wikimedia Commons

As a science, medicine seeks to define things in specific terms. As a natural process, childbirth doesn't always fit into perfect little boxes. Childbirth education often uses the explanations from medicine in attempts to help women understand the birth process. However, based on my own observations, the "textbook labor" does not apply to the experiences of a very large proportion of birthing women, and I wonder if we are, by using it, doing women a disservice by creating false expectations.

The general model that is taught is that there are three stages of birth: dilation, pushing, and birth of the placenta. Within the dilation stage, three phases are taught: the early/latent phase, active phase, and "transition."

• Early phase is usually defined the time when the cervix is going from 0-3 cm dilation, and is characterized by pressure waves that are spaced far apart and my be irregular.
• Active phase is defined as cervical dilation from about 4-7 cm, and is when the waves get regular and increase in intensity and frequency and cause measurable cervical change.
• "Transition" is when the cervix goes from 8-10 cm, and is usually explained by its physical and emotional intensity and the presence of symptoms such as shaking, nausea, and vomiting.

There are a few problems with this construction.

• If this is the "normal" birthing women whose births do not fit this pattern may consider what they experience as "abnormal."
  
• It relies very heavily on measuring the cervix as a basis for knowing how far along a woman is.
• Some women's cervices will be reach dilations where thy should be in "active phase" but stay there for days or weeks before the baby is born, and there is nothing pathological going on
  
• I specifically disagree with the way "early/latent phase" is characterized.

The impression that this model gives is that from "not in labor" to "in labor" is a one way street; once "labor" begins, you are "in labor" until your baby is born. I feel that this construct, together with unrealistic media portrayals of childbirth (where it always seems like a woman is going along minding her own business, suddenly her water breaks, chaos and rushing ensues, as well as some screaming, and then someone is handing her a "newborn" the size of a 3 month old), encourages women to head to the hospital as soon as they have contracting sensations that they can tell are more intense than the Braxton Hick's they have been having.

I have been participating in an online support forum for women who are planning natural births for about 3 years now. On our group, we have a fun tradition called Lodges, which are a sort of journal for pregnant women that lasts from 36 weeks to about 1 month postpartum. I have followed many lodges in the past three years, so I have read updates from women as they are nearing the births of their babies. From my own informal observations, it appears to me that a majority of women experience periods of regular and intense pressure waves (not Braxton Hicks, but the same kind you have during birthing) on and off for days, weeks, and in some cases months, before giving birth. They will go long periods with no pressure waves, then have them start again for a few hours, then they'll go away. So, does early labor stop? Can early labor last for two weeks? Or is our idea of "early labor" a myth?

Some people would call the off-and on periods of pressure waves "false labor," but I really dislike that language because it implies that the woman doesn't know what she's feeling. In many cases, the only way to tell the difference is in retrospect: sometimes they go away and sometimes they continue to the birth of a baby, they usually don't really feel much different from each other, contrary to what some will tell you. "False labor" also implies that it is not doing anything, and I am of the opinion all pressure waves do something, even if it is not causing measurable dilation. It could be effacing the cervix or encouraging the baby to rotate into a better position. In some cases, dilation is occurring, just not quickly enough for it to be measurable. For women who have "false labor," it may just be that their body does the "early labor" work incrementally, with long periods of rest.

The problem is that I suspect that the majority of women don't know how common start-stop labor (as I like to call it) really is. I recently read a blog post by a nurse (shared on facebook by The Deranged Housewife) who blamed the "need" for hospitals to use pitocin on women going to the hosptial and getting epidurals too early. Comments on the facebook link suggested that the problem is not the patients themselves, but that someone is failing to adequately inform them what the end of pregnancy is really like. The nurse's post really made me wonder how many women are getting pitocin for "stalled labor" when actually they were having an episode of pressure waves that would have gone away? How many of these babies would actually have come days or weeks later without the pitocin?

(On a similar note, I also love this post by midwife Stephanie of Vita Mutari questioning the logic that it is "safe" to "labor at home as long as possible" in order to avoid crowding the labor and delivery floor and avoid interventions, yet "unsafe" to plan a homebirth with a midwife.)

The concept of "early labor" is misleading because it is so easy to mistake start-stop labor for "early labor," and if women assume "this is it"and run to the hospital at the first sign of a pressure wave, they are guaranteed to either be sent home disappointed or have a whole lot of interventions, and neither of those is a desirable thing. I know I fell into the "early labor" trap myself with my first birth--I remember thinking "I've been in early labor for two days and I'm only 1 centimeter?"

For real, human women, not mythical "textbook" ones, the onset of the birthing time is a fluid process that they may move in and out of at their own unique pace. The last few weeks of pregnancy are the orchestra tuning up before the concerto, the engines revving before the race.

ABC's Rookie Blue spreads stereotypes of doulas and homebirth

Last night, my husband and I caught a re-run of Episode 7 of ABC's summer series Rookie Blue. This was our first time seeing the show. It follows the lives of five fresh out of The Academy cops.

Episode 7 featured a power outage during a heat wave. One of the story lines involved Officers Gail Peck (Charlotte Sullivan) and Dov Epstein (Gregory Smith) stumbling upon a pregnant woman in her apartment who appears to be in labor, characterized by her grabbing her belly and screaming bloody murder every few minutes. She says she is not due for another month. Her water breaks, and after she is shown on the phone, she tells the cops that she is planning a homebirth and has just spoken to her midwife and is calling her doula next. Gail turns to Dov and asks him "What is a doula?" to which he responds, "A birth coach for hippies." Peck replies "I thought a birth coach was a birth coach for hippies." I was so offended by this characterization of doulas, I almost demanded my husband change the channel right then. Doulas are for everybody, and it is not only hippies who desire natural birth or homebirth. I wanted to see how this scenario played out, so I kept watching.

Dov eventually realizes that the woman is agoraphobic and she tells them she has not left her house since she went off her meds when she started trying to get pregnant. While a woman going off her meds for the sake of her baby is highly commendable, this show seems to suggest that women who choose homebirth must be psychologically unstable or at least have irrational fears. So, now the message I'm getting is that women would have to either be a hippie or psychotic to want a homebirth, and this is far from the truth.

Despite Gail's insistence that the woman's baby is in danger and that they should just arrest the woman and take her to the hospital (really?), Dov sees that the baby is coming fast (as is typical of television births) and he is going to have to "deliver" it himself. Dov catches a very large baby for being "preterm" and which has no vernix on it, and Gail cuts the cord the second the baby emerges, with no mention of clamps (the myth that it is necessary to cut the cord immediately has GOT to stop!) Dov convinces the woman to go with her baby to the hospital to get it checked out (a good example of a woman willing to do anything for her baby), and Dov and Gail grin at each other over the experience.


Gail even later tells her boyfriend that how great she did (what did she do besides bring negativity to the room and prematurely cut an unclamped cord?) On the other hand, perhaps Dov should leave the Force in favor of becoming a male midwife?

If you want to watch the episode yourself, you can view it here.