Your labour has started. Contractions are coming regularly and strongly. But then at some point you notice things slow down. Or even totally stop! It can be that you are very happy, and you feel you are getting the break you were longing for. Or maybe you feel you want to change something: getting into another position or changing your movements. It is also possible that you have no idea why things are slowing down, and you feel somewhat disappointed.
In this blogpost I will talk about pauses in labour. Are these normal? (Yes!) When and why do these occur? Is it a problem if your (partner’s) labour pauses and what should be done if this happens? What is the relevance of all this in your preparation of the birth of your baby?
This blogpost is written from the perspective of the birthing woman. However, if you are a birth partner preparing for birth, I also encourage you to read this article, as it will help you having realistic expectations and prepare for your own role during birth.
Pauses are part of the physiological labour pattern
Each woman, each baby, and each birth are different. The rhythm of childbirth remains a mysterious thing, no matter how much it is researched. There is a huge spectrum of what can happen in physiological birth, and a slow-down, pause or stop of the labour are all part of that. This means that if a pause occurs during your labour, this in itself is not a (medical) complication. Pauses in labour can happen at any time in any phase. The most common slow-down happens when women go to the hospital to give birth to their baby.
Often a pause in labour is a self-regulation of the mother-baby dyad. This means that the pause has a function and is for the benefit of the overall birthing process. In 80-90% of the cases, there is NO ACTION required for the pause to pass by and labour to continue. It is common that the labour intensifies and accelerates, after a pause has resolved itself.
What is causing these normal pauses?
There exist lots of reasons why labour can slow, stall or stop. It can be that the environment is not right, for example when the mother is disturbed too much. The pause may be caused by the baby that for example needs to reposition itself, or that requires a slow down in contractions as the umbilical cord is compressed. When the mother is scared or anxious, labour may also stop or slow down. The below picture gives a good overview of common reasons for labour to pause.
Misinterpretation: ‘Failure to progress’
When women are put on a timeline, and their labour is expected to show a continuous progress over time, a pause is easily misinterpreted as a problem. It might be concluded that there is a so-called ‘failure to progress’. When a pause is not considered normal part of the labour pattern but is considered an issue, this almost always results in medical actions to speed up the labour such as breaking the amniotic sac or an injection of man-made oxytocin.
What if interventions are proposed? Using BRAIN in your decision making
If you experience a pause, and you are at some point offered a medical intervention to speed up your labour, you can use the BRAIN model for decision making.
It is important to know whether the pause in your labour is a sign of something actually being wrong, or whether it is just part of your and your baby’s individual labour pattern.
Possibly the most important question to ask yourself: Am I safe and is my baby safe? Your own intuition is an important indicator of this. When something is off, women often ‘feel’ or ‘just know’ this.
Of course you can also discuss this with your care provider. Let him or her know how you feel, and how you feel about the proposed intervention. Other questions you can ask are: Is the intervention proposed because I do not meet certain time criteria? Is this for example only based on the amounts of centimeters measured during a vaginal exam, or are there more reasons?
Sometimes women are told at the hospital that the reason for the proposed intervention is money, with the rationale that it costs more money if the labour takes longer time. Keep in mind that in your own decision-making you never need to include budgetary reasons!
Connect with your body during birth
Hopefully the knowledge that in about 80-90% of the time, a pause will resolve itself, makes it easier for you to trust your body.
Looking at the most common reasons for a pause in labour as outlined in the picture above, it is also quite evident that it helps to maintain as much as possible your birthing bubble and connect with yourself and follow your body and baby’s rhythm in the 'labour-dance'. Drink when you feel thirsty, move when you feel you need to, rest when you are exhausted and focus on your breathing if this helps you to clear your mind, etc. Your birth partner can be a great support in these things.
A detailed explanation and discussion on physiological labour in general is included in NatalWisdom’s birth preparation course as well as an explanation of the BRAIN model to make decisions.
Credits
This blogpost is heavily inspired and based on a research article by Marina Weckend et al. published in 'Women and Birth': Failure to progress or just normal? A constructivist grounded theory of physiological plateaus during childbirth. From this article I have taken many quotes and the above picture. Most credits for the content of this blog therefore go to Marina Weckend et al. Reason to write this blog post is to make the useful information from this research easily accessible for you. To read the whole article by Marina Weckend et al visit https://doi.org/10.1016/j.wombi.2023.10.003.
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