One concern that some expecting families seem to have is with regards to how fast their birth is going to be. They are often concerned that they will not have time to make it to the hospital. This concern seems to be partially instilled by Hollywood, for example in the TV shows Frasier and Grace and Frankie. There aren’t very many studies that have been done on precipitous labors and non-scientific websites that discuss these are often inaccurate in the information they give. In this post I wish to discuss three different things: things that can be done to speed labor up, unattended births, and what we know about precipitous labor.
How fast is normal labor?
In normal labor it takes two to six hours to dilate from six centimeters to complete. Early labor can last much longer than this, about 2/3rds of the total birth time.
Are there any activities that can speed normal labor up?
There are definitely exercises that can be done to get the baby more engaged in the pelvis. Spinning Babies talks about a lot of great exercises to get baby engaged during pregnancy. I also encourage clients to go see a pelvic floor physical therapist, acupuncturist, or chiropractor to see what their body needs to get ready for birth. Once a client reaches their due date I encourage them to start self-induction techniques to get labor going before doctors may encourage them to schedule an induction. Labors that start naturally also tend to be faster than labors started with medical treatments that can take a long time to get labor going (or make things more painful for the birthing individual).
Doulas are also associated with shorter labors and labor that begins naturally rather than through induction. The more education you have prenatally and the more support you have throughout your birth the better your birth will go and the more likely you are to have a faster birth. Childbirth education is also extremely important for this reason.
What is precipitous labor?
Precipitous labor is not the same as normal labor, nor can it be simply caused by speeding up normal labor.
Precipitous labor is defined as less than three hours from the onset of contractions to the time of birth and only occurs in less than 2% of all births in the United States, according to 2006 statistics (Williams and Lowdermilk). One study of 99 precipitous labors found that that cervical dilation was 5 centimeters per hour or faster for nulliparas (women having their first child) and 10 centimeters per hour for multiparas (women who have already had a child), though more common in the latter. Each birth statistically tends to be faster than the last so knowing how fast previous births went can tell us what we're expecting. Of course this does not always hold true. Sometimes second births can be longer than first births for a variety of reasons.
What do I do in an unattended birth?
Aside from the media one other thing that causes us to think about fast births is the fear that we may miss our opportunity to go to the hospital and accidentally give birth in a car, at home or somewhere else where there is no care provider, also known as an unattended birth. For the 2% of the population that does have precipitous labor this chance of unattended birth increases. So what are we supposed to do in these situations. If the hospital you intended to give birth at is too far away you can go to any hospital with a labor and delivery ward, so find your nearest one in advance. You could also call 911 but this is generally not ideal, you still have to wait for them to come and when they do come you're just asking them to take you to this hospital you found. Instead it's better to drive to this hospital. As Rachel Yellin notes in her wonderful San Francisco childbirth classes if you can insert your finger in your vagina up to your second knuckle then you can make it to the nearest hospital. If you end up having an unattended birth catch your baby, make sure they're breathing properly, you may need to put them head down and feet up a little and pat their back to get liquid and things out, and keep them skin to skin so you can do your best to keep them in a hygienic space until you get to the hospital.
Wouldn't it be great if everyone could have such short labor?
Unfortunately the situations that cause precipitous labor are not ideal. The complications of such a labor are even worse.
What causes precipitous labor?
There are a few things that can cause precipitous labor including preterm labor, hypertensive disorders, and cocaine abuse. It can also result from hypertonic uterine contractions that are tetanic in intensity, in other words abnormally strong contractions. This study also showed that individuals who give birth when they are teenagers also tend to have more precipitous labor. In some rare cases this can also happen when the birthing individual’s contractions are not painful and they are unaware of how fast their labor is progressing. Though the studies I looked at do not mention this, I always make sure to ask my clients how long births typically are in their family because I heard a midwife once say this to a family who was mentioning their own family history. For example a mother can have a fast birth if her mother gave birth to her first child in a very short time (for example a total of two hours). I ask both the expecting mother and father about their family history.
What are complications of precipitous labor for the birthing individual?
If the body is prepared for a precipitous labor, in other words if the cervix is effaced appreciably and compliant, the perineum is relaxed, and the vagina has been stretched previously then serious complications are seldom. If these conditions are not true then precipitous labor can result in uterine rupture, postpartum hemorrhage, placental abruption, and extensive lacerations of the cervix, vagina, vulva or perineum (Lowdermilk & Williams).
Precipitous labor can also have emotional consequences. Initially there is often a period of panic about potentially not making it to the hospital in time to give birth, followed by a feeling of relief when they arrive at the hospital. Once inside the hospital, or prior to arriving at the hospital, the birthing individual may be frustrated when individuals don’t believe them about their readiness to push. The birth itself can leave the birthing individual with feelings of disbelief and alarm with the speed at which the labor occurred.
What are complications of precipitous labor for the baby?
Abnormally strong uterine contractions can prevent appropriate uterine blood flow and fetal oxygenation. This can cause a number of different potential issues with the baby. I have listed these in order of how common they are with the most common first. The first is that the baby can get stressed and let out some meconium into the amniotic fluid. If this meconium is breathed in by the baby it can cause a number of different issues with breathing. The second thing that low fetal oxygenation can cause is hypoxia or too little oxygen reaching the tissues. One study showed that of individuals who got Erb or Duchenne brachial palsy, in other words a paralysis of the arm due to injury to its nerves, one third of them had precipitous labors. In much more rare situations, a precipitous labor can cause amniotic fluid embolism or intracranial trauma. Amniotic fluid embolism is a rare childbirth emergency in which the heart and lungs collapse and massive bleeding can occur. Babies with any of these conditions will be automatically given a low Apgar score at birth, a score that determines the physical health of the baby on a scale from 1 (least ideal) to 10 (most ideal). Unattended births have their own set of concerns, including newborns who fall to the floor, are injured or may need resuscitation that is not readily available.
What might be done to treat precipitous labor?
Unfortunately most of the things that have been done to stop precipitous labor have been shown to be ineffective. It is not likely that analgesia, general anesthesia with agents like isoflurane, or tocolytic agents such as magnesium sulfate will change the abnormally strong uterine contractions that are associated with precipitous labor. If any oxytocin agents (like pitocin) are being given to the birthing individual they should be stopped immediately.