Currently I am reading The Labor Progress Handbook by Penny Simkin and Ruth Ancheta. This book has been on my reading list for a while, however with clients having babies and taking care of my own family, I am just getting around to it. The book discusses labor dystocia and non-invasive techniques to treat or prevent challenging labors. The book states 60 percent of all cesareans (primary and repeat) are attributed to labor dystocia (pg. 3). I have been in several births where a stall in labor or a long labor created difficulties for the mother both emotionally and physically, as well as made interventions more plausible. My desire is to learn more about these non-invasive techniques to help my clients navigate long and difficult labors. Although I have not completed the book, I want to share a few insights from the opening chapters.
At the beginning of the book, the authors outline premises the book is build upon. One specific point I appreciated was the premise women are treated as the key to the solution not the problem. Often times when a woman’s body is not cooperating as expected in labor, the woman and those supporting her can assume something is wrong with her body or labor. This assumption may lead to unnecessary and unwanted interventions. On the contrary, I have noticed when a woman is well supported she often intuitively knows what to do. For example, I attended a birth where the mother had a premature urge to push. It was very strenuous on her body physically and emotionally. She was literally grunting through every contraction but only at 6 centimeters. She found herself in the open knee-chest position without any coaching, which was perfect for her situation. It was a great learning experience for me to witness a mom listen to her body and work with her labor.
Another premise I took note of was, “Time is usually an ally, not an enemy. With time, many problems in labor progress are resolved. In the absence of clear medical or psychological contraindications, patience, reassurance, and low or no risk interventions may constitute the most appropriate course of management.” (pg. 5). In the previous example I gave, the mother also experienced slight swelling of her cervix due to the premature urge to push. Her doctor and nurse encouraged her to continue laboring and check again in a few hours. At the next cervical check she had no swelling and had dilated a few more centimeters. She went on to deliver her baby vaginally, unmedicated and with no interventions.
Obviously, there are times when lifesaving interventions are needed and necessary for the health of mother and baby, however waiting a few hours before medically intervening can be an effective technique for managing plateaus or long labors. With my pregnancies I always asked for reassurance from my care provider that as long as 1) I am okay and 2) the baby is okay I would like as much time as needed to deliver my baby. Thankfully, this was fully supported in both of my deliveries especially with my first which was a long labor.
Have any of you read The Labor Progress Handbook? What did you think? Has it been helpful in your role as a doula or during your labor?