Coping At All Stages - Active Labor

"For my first, I received an epidural around 4cm and no one told me the risks associated with it. I continued to labor, but could rest because of the epidural. I got to 5cm, but didn't got past 5cm on the clock that they expected. At 7pm they recommended a cesarean, which I declined. At 8 pm they said the baby was in distress and i needed a cesarean for his life. At 9:16, he was born by cesarean. 

For my second, by 10:30am I was in active labor My midwife had to work my cervix through some scar tissue, but I went from 4-6 within moments. My doula did a lot of work with me but I wasn't prepared for the intensity of active labor because I didn't do childbirth class. She helped me through a lot of mental blocks.

For my third, immediately I felt the need to go to the bathroom. As soon as I moved, my water broke everywhere. I got to the restroom and immediately had another intense contraction with more fluid gushing..." ~ Allison

"When the pressure got big enough and the discomfort got big enough that I needed help, I called Cole. She met me at our house and I worked through things in the shower. My contractions got closer and closer throughout the day, but it was slow going. I ate breakfast with my husband, lunch with Cole and my husband, and we got dinner on the way to the hospital. It was always very manageable. They were big and demanded my attention, but as long as I could mentally check out and just roll with it, I was good. We got to the hospital and checked in. Cole says my contractions were about 4 minutes apart at this time and big. My first nurse was awesome. She turned down the lights and left us alone except for an initial cervical check to tell me I was 6-7cm. I was given a hep-lock and they put me on the monitors. The monitors were really uncomfortable. My nurse had to leave though and my second nurse was rude. She flipped on all the lights and wouldn't leave my room. This change in staff happened around 10pm. She kept barking orders at me and making me feel like I was managing all wrong. I finally went to the shower to get away from her. This worked until sometime in the middle of the night. At that point, she told me I had to get out. When I got back in the room, I was so tired and annoyed. She asked me if I wanted my epidural. It really sounded good. I asked her to check my cervix. I was 7cm...." ~ Amili

"I went out for Mexican food and all the patrons were giving me concerned glances because, by that time, they were more like 4 minutes apart and I couldn't talk through them. Then I knew I was in 'real' labor. I called my midwife and she said to make my way to the birth center. I started walking around the birth center for what felt like 20 minutes but it was more like 2 hours, pausing periodically for black cohosh, which tasted like dirt. When a contraction would come, I would squat down and sway my hips while either my partner or my doula would hold under my arms..." ~ Chelsea

"We went to the chiropractor at 10am for my appointment and my chiropractor pointed out to me how my backache was making my belly hard. I was in labor. After my adjustment, we went to our local breakfast place and had brunch. Half way through our meal I took a huge gulp of OJ and, for one confusing moment, thought the juice dribbled down between my legs. But my water had broke. We finished eating as quick as possible and I hobbled out to the car. Thankfully I was wearing a black skirt and the only ones who knew was my husband and I. I decided I wanted to be in the hospital and we called Cole to us. She met us at the hospital, where they had changed from backache to BACKACHE.  I was 5 cm at check in. She recommended some belly shifty thingy and all fours. My back felt immediately better and I felt like I was on top of things. Contractions were now about 3-6 minutes apart - they would come in sets of three close, then one further away, then three closer together again. I was really getting into a rhythm and only really felt how tired I was. It was painful but manageable. We did this for about 8 hours." ~ Liv

"I was managing my contractions with the vibrator. I texted my birth team that my contractions were lasting a minute every 7-12 minutes. An hour later, My contractions were 6-10 minutes apart, lasting almost a minute. I was flipping through a breastfeeding book and sitting on the birth ball TDD started timing my contractions but he was in charge of various duties so only managed to record a few. The first was fifty-two seconds; three-ish minutes between this one and the next few. We were unable to time them religiously so he told my midwife they were about a minute long, every three minutes TDD and I cracked jokes between contractions, but the ache in my sacrum and hips was constant. I tried not to worry about it. I told TDD I thought I was probably still dilated at a two, so he reiterated to my doula that it was okay if she wanted to go home and shower before heading over..." ~ Holly

"Around 8am, the cervical tickles were starting to feel like licking a battery with my cervix. I remember Cole telling me this can be a good sign for dilation. I got up to use the restroom and noticed they were coming pretty close still, but felt longer and definitely stronger. I didn't really need help, but I wanted my people. So I called my doula to come to me, asked my midwife to start making her way over, and woke my husband up. I preferred laboring on all fours in the bedroom, but kept going back to sit on the toilet every few contractions. They stayed 'easy' and I only really needed to breath hard through them and shake my head to stay loose. I could talk through them, but it was like asking someone to talk during an orgasm - you can, but it's so distracting. Cole turned off all the lights and made it nice and dark by drawing the shades. The only noise I wanted was affirmations and the only thing I wanted was presence." ~ Trinity

"Things picked up slowly and steadily and sure enough, when I really wanted to rest I couldn't because my contractions demanded that I was up and moving, rocking and swaying. My contractions went from 10 min apart to 7 min apart to 5 min apart over about 15 hours. I would only really consider them INTENSE intense for the last 5 hours of that, when they went from 7 minutes apart to 5 minutes apart. When they got about 7 minutes apart I couldn't just change position to make them better, I had to make noise. My doula showed up when they were about 6 minutes apart and worked with me to make positive noises. When they were 5 minutes apart for a good hour I decided to go in to the hospital. I just wanted to sleep but lying down wasn't working. I hated that position the most. My contractions were 3 minutes apart by the time we got to the hospital. They checked my cervix and I was 4cm. I was frustrated." ~ Kelly

Active labor is when your labor/contractions actively require your help. This is usually when your contractions are closer, longer, and stronger than they had been prior... Again, ignoring your labor as long as possible will help it go smoother and feel shorter/more manageable. When you arrive at active labor, it is difficult or impossible for most women to ignore the sensations of labor, and contractions are easier to cope with when you adjust your body to the sensations.

Textbook active labor is 5-6 cm on through 7-8cm and when your contractions are between 7 - 4 minutes apart, and lasting between 45 seconds and a minute each. Pro Tip: again, try not to watch the contraction app all the time. 

I'll reiterate, our bodies don't necessarily follow the textbooks and it's important to listen to what sensations you are feeling, how your body is coping, what positions you prefer, and what else your body is telling us emotionally, mentally, and physically. If your water hasn't broken yet, there is a good chance it will break sometime during active labor. Pro Tip: keep note of your water when it breaks. What did it look like, smell like, color, big gush or little trickle, etc... 

You might also see bloody show if you haven't yet. If your water already broke, it will continue to leak in small trickles, normally with contractions. You might notice that you begin to feel contractions in your hips, back, or butt. Pressure in your vagina or butt is normal the more open your cervix gets and the lower your baby moves. Pro Tip: if you aren't sure if you'll like massage or counterpressure - give it a try. If they are pushing or massaging in the wrong place, tell them where you need it by pointing. Tell your birth team how hard you want it by saying 'more' or 'less' or 'stop'. 

Contractions don't normally feel any 'bigger' after you get to around 7cm, they just continue to get closer and longer, with more constipated pressure. It's not uncommon to lose your appetite around active labor. Remember to drink water often, though, and use the restroom often. Pro Tip: Keeping your bladder empty will ensure baby can move down and that your uterus doesn't get over stimulated. 

Movement, falling into a relaxing rhythm and ritual, will help make time go faster and labor go smoother. Find positions that work for you and ambiance that allows you minimal distractions. Whatever you would do to make a romantic or sleep inducing atmosphere is the perfect atmosphere for active labor. Pro Tip: do what you need to to let your body surrender to the sensations. If someone is causing you to feel inhibited, they should leave. If you want to moo, then moo. If you want to get on all fours, do it. 

Example of ritual
Contraction, I spread my legs and sway my hips while leaning on the bed. Doula pushes on my hips. Husband moans low with me to give me a vocal goal. At the end of the contraction, he reminds me to take a deep breath and as I finish blowing it out, he kisses me. Mom offers me a sip of water. I stand up and stretch. Contraction, I spread my legs and sway my hips while leaning on the bed. Doula pushes on my hips. Husband moans low with me to give me a vocal goal. At the end of the contraction, he reminds me to take a deep breath and as I finish blowing out, he kisses me. Mom offers me a sip of water. I stand up and stretch. At the end of each hour I go sit on the toilet for 3 contractions.
Speaking of positions, if you change a position and don't like it, (pro tip) give it 3 contractions before abandoning it. It will take your body that long to adjust to the new position. Resist the urge to raise up on your heels or clench your butt/pelvic floor/thighs and, instead, focus all of your attention on letting go of all tension in your body. 

Speaking of romantic - romantic things like kissing, nipple stimulation, nuzzling the neck, making out, even orgasm - these are great things for any time during labor but especially during active labor. Be mindful of your tone - vocalization is a powerful tool. It's ok, in fact it's downright good, to make noise. 

If you're not yet at your place of birth, this might be the time that you decided to head in. When you arrive, if you are at the hospital, they will likely: 
  • draw your labs - a blood draw to check your blood type and your platelets. 
  • put in a hep/saline-lock or an IV - they will normally put this through the same spot as your labs and don't require another poke. Pro tip: consider before hand where you might prefer the IV to be placed. If you have a lot of vein options, you might have a choice of where it goes.
  • Ask you to give a urine sample at check in. 
  • Ask you a series of questions about your health history.
  • If your water broke, they might do a swab or speculum exam to check if your water did, indeed break. 
  • Check your cervix to make sure that it is opening and your cervix is making change. Pro tip: cervical checks in labor can be VERY uncomfortable - a trick is to act like you're blowing their fingers out while they check you. This allows your cervix to come lower, making the exam easier on you and the person checking.
  • Monitor babies heart rate, your contractions, your temperature, and your blood pressure. Pro tip: they usually have you in the bed to put on the monitors. Once they are on, you can get up and move around the cabin to the extent the wires will allow you to.
  • Ask you to change into a gown. 
If your hospital has a triage or assessment center prior to moving you to labor and delivery, you will normally have all of this done in triage/assessment. If your cervix is not at least 5cm and your water hasn't yet broken, it's not uncommon that they would have you labor in assessment until you make another centimeter cervical change or your water breaks. Once you arrive in your birthing room, it's not uncommon for a second cervical check and set of vitals on baby and you to be done. 

Standard care in most hospitals is: 
  • to at least intermittently monitor baby and your contractions (15-20 minutes out of every hour), and many times continous monitoring once you've reached active labor
  • to give IV fluids, or at least have access in place should an IV be required (hep- or saline-lock)
  • to check your cervix every 2-4 hours for change, depending on where you are at in labor and if your water has broken or not
If you are birthing at home or the birth center, the standards of practice are different, and you should ask your midwife what you should expect when they first come to you or you first arrive to them. This wraps up our active labor overview; up next: transition. 

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