The Stages of Labour (and why they kind of don't matter)

According to any textbook there are 3 stages of labour. The first being your dilation and effacement, the second is pushing and birth of baby. Third is the birth of the placenta.

The first stage is further broken down into 3 parts. Early, Active, and transitional labour. These are characterized by length and space of contractions and how dilated you are, often assessed by vaginal examinations (VE).

As a general guide for education on what happens and what to expect, I use these parameters regularly. However, in my experience and the more I learn, read, and see, I am seeing how these parameters are being used outside of their original intent.

A Dr. Friedman published a study in 1955 that gave an average time for labour. He had it all plotted out that the average woman would take about 8 hours to go from 0-4cm, 5 hours to go from 4-10 (active labour), then pushing for about an hour. So, What ended up happening is that these findings were then put in as strict guidelines and now women are put on a clock at admittance into hospitals. Now, progress is expected to be at about 1 cm per hour once admitted (when active labour is established). If you progress slower than average, you will be offered pitocin to speed things along, you will be offered VEs to ensure you are progressing at the "correct" rate. If you continue to progress slowly then you will be labelled "failure to progress" and possibly be sent down for an emergency cesarean, or likely be told you need instrumental assistance to "help baby out."

A study has been published with ACOG (American College of Obstetrics and Gynecology). I won't go into all of it but you are welcome to read more here. It says that, historically, prolonged labour was defined as latent labour lasting longer than 20 hours for first-birth mothers (nulliparous) and 14 hours for mothers that have already given birth before (multiparous). Slow active labour is a progress of less than 1.2 cm/hr or 1.5 cm/hr for nulliparous and multiparous women respectively. Labour arrest is no change in the cervix for 2 hrs after already reaching 4 cm. They note that 34% of first time cesarean births are due to Labour arrest. The following image is from the article.

It likely will not come as a surprise to you that I largely disagree with this method of turning women through the maternity wards like a conveyor belt. There is a wide range of normal. Many do not fall into this average range and their births get tampered with. Many will find themselves progressing in and out of stages. If you have ever heard the term "false labour," you know that early labour can look very different on different people. Early labour can take a couple days! Not just 8-20 hours. You may be trucking along in seemingly active labour and it may slow down again and give you rest. That doesn't mean you aren't birthing your baby, all labour is good and purposeful. The position of your baby can change how things flow as well. There is no "right" way to birth your baby. Don't try to trap yourself into a time box.

If we would just largely leave birth alone, stop telling women that their bodies may not birth their baby, stop interrupting their concentration and relaxation, stop poking around and needing to invade their most vulnerable areas, and stop telling them that baby needs to be out sooner (further stressing a mama) they would, by and large, be able to birth just fine in their own time. Bright lights, loud noises, being restricted to bed in the case of continuous fetal monitoring that isn't wireless or epidurals, can all keep labour at a slower pace. Many women, if they can, tend to gravitate toward the shower in the dark bathroom for privacy, security, safety, and calm. This is how our bodies progress well.

I will add this caveat: I know that we need access to cesarean birth options, we need access to induction and epidurals. My complaint is 100% against putting women in a box, expecting their births to conform to a certain pattern and then, going against nature, UNNECESSARILY intervening with pitocin and vaginal examinations to make them fit into some arbitrary standard. I am so thankful we have life saving options. I think greater discernment needs to be used on the necessity of their usage. If mom and baby are well, then I say give them a chance, let's change positions, give baby room to move around and get through the birth canal on their own.

Within the article they further go on to say that more current research shows that most women labour slower than the previously assumed average and that active labour should be redefined as after 6cm, not 4. Unfortunately, what we run into is that the research takes a really, ridiculously, long-time to become the norm. Hospitals tend to be quick to implement procedures and policies that take further action on the mom and are slow to retract them when evidence shows they are not necessary. As an example of this, while the rates have dropped significantly, there are still obstetricians that are quick with the episiotomy even though the research against that has been very widely known for decades and officially recommended against since 2006. It is a long and slow process for change to happen when it puts the power back into the mother's hands. Usually this is with the best intentions and a need for obstetricians and hospitals to protect themselves but as they say "the road to Hell is paved with good intentions."

My hope with this post is that you will look at and learn about what physiological birth is actually like, know what your rights are, and decide what you are willing to allow to happen to your body in your birth. Make it be known to your providers. You are fully capable of making these decisions. Just because it is "policy" that doesn't mean you have to agree. If you do agree, then it will be with full knowledge and you can be confident in your decisions.

Happy birthing.