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Page 6 Edited.

It's taken me a while to get to this but better late than never I say! What I'm talking about are my edits for page 6 of Comforting Touch for Birth on the phases of labor.

Even if you don't have a copy of the guide, if you're interested in birth, you'll want to keep reading.

First, big thanks to doula and childbirth educator Stacie Bingham for her notes on this topic. The biggest change, which she reminded me of, reflects ACOG (The American College of Obstetricians and Gynecologists)'s 2014 decision to mark the onset of active labor at 6cm dilation, rather than the previously purported 4cm.

In line with this shift, ACOG’s guideline now defines failure to progress as "women at or beyond 6 cm of dilation with ruptured membranes who fail to progress despite 4 hours of adequate uterine activity, or at least 6 hours of oxytocin administration with inadequate uterine activity and no cervical change."

This change not only aligns more with what is more typically seen in birth but it also helps to dial back the expectations that labor should move at a faster pace so early on. This takes the pressure off laboring people and care providers to intervene less frequently, at least in theory, because if, for example, there is no cervical change at 4 cm for 6 hours, labor hasn’t stalled, she just isn’t in active labor yet!

In response to this, I like the trend in childbirth education to re-write the traditional phases of labor to include this awareness. Instead of marking Early, Active and Transition as the sole phases of first stage labor, educators are adding a warm-up phase usually correlated with cervical dilation between 0-3 cm when “labor” is entirely best ignored while rest, normal activity, staying calm and nourishment are paramount. The early labor leading up to active labor between 4-6 cm dilation is a time to continue these practices while recognizing that while the need for comfort measures may increase, the need to intervene is unnecessary.

  • Warm-Up: 0-3 cm (Ignore, Rest, Eat, Drink, Exciting!)

  • Early: 3-6cm (Increase comfort measures, continue to drink, eat, rest and move as desired, mood may increase in seriousness)

  • Active: 6-8cm (Use all the comfort measures, stay hydrated, rest and move as desired, expect a total loss of social self and other signs of progress such as shakiness, nausea, and getting hot and sweaty)

  • Transition: 8-10 cm (Shortest phase but greatest chance of self-doubt, use all the comfort measures, may have an early urge to push, greatest need for verbal re-assurance and encouragement.)

Promoting a sense of safety is key at this stage as it is in all stages but one important understanding of why can be derived from how animals give birth in the wild. If a creature in the wild begins labor but senses potential threat, they (by a hormonal response) will stop labor’s progress until they can get to safety before allowing labor to begin again. However, the closer an animal in the wild is to giving birth, when potential threat is sensed, labor will speed up (through a cascade of hormones) to finish getting the baby out before getting to safety.

For first time parents birthing at a birth center or hospital, transfer to your place of birth is best delayed until true active labor is underway out of respect for this biological propensity for labor to halt if it's too early. And you'll want to keep an eye out for 2 of the following 3 signs to track your progress:

1. Fresh bloody show (a sign of significant cervical change)

2. Urge to push (may feel like a need to poop but nothing comes out)

3. Contractions are 3 minutes apart, lasting for 1 minute, for at least 1 hour (3-1-1)

This shift by ACOG and childbirth educators seems to reflect this innate tendency and should be considered to be a more accurate portrayal of the birth process, at least from an externally measurable perspective. I hope you will add these insights into your understandings while reading and practicing comforting touch for birth.

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