Throw Your Clocks out the Window

One of my pet peeves is the fact that the most widely used tool parents-to-be are taught to use to determine the progress of labour is the great "timing the contraction" ritual.

When a woman begins to feel like she's in labour, what's the first thing she's taught to do? Time the contractions. What is UP with that?! To what end? In most books and in most classes, women are taught to go to the hospital when their contractions are 4-5 minutes apart, are lasting 45 seconds to a minute, and have been doing so for a couple of hours. Not being able to speak through them is also suggested, but people get so caught up in those numbers, they ignore that second bit of advice.

I tell people to NOT time contractions, at least for the first part of labour, anyway. It's a tool, like any other, but should never be used on its own. What's the best way to make something "bigger?" Pay all kinds of attention to it, and worry about whether or not your process is comparatively normal and "fits in". So by the time contractions hit the magic number (if they ever do, as some don't), a woman thinks she's really getting somewhere and is usually figuring she's in some kind of active labour when she gets to the hospital. This is because the numbers game has set up an expectation, which, in my years of experience simply observing labour, can make for harsh reality checks. Women who are taught to time their contractions as the primary tool for determining how labour is progressing often are the ones who end up saying, "my labour was SO long! I was in labour for 36 hours!" (which is actually not abnormal for a first time mom taking into account all the contractions). Those who choose not to pay much mind to their contractions until it is clear they are absolutely requiring attention tend to perceive their labours as shorter and more manageable.

Lots and lots of women walk into that hospital chatting and smiling, able to analyse their contractions, misled to believing they're just a few hours away from birthing, because they've been given a formula within which to fit their labours. Then when they're examined and told they have ages to go, they get discouraged, and the cascade of intervention begins. How disheartening it is to think your cervix "must" be at a certain amount of dilatation, and you discover in truth, you are only just starting out. Women end up believing they are defective in their birth giving capabilities, when it's simply not true. It was just the expectation that was not realistic.

I have had women call me saying, "My contractions are 2 minutes apart! I guess I should go to the hospital now, right?" I'll ask, "Are you having one now?" And they'll answer, "Oh, yes, I'm having one now while we speak." Well, just because one is having frequent contractions doesn't mean the baby is coming! I will be encouraging and tell her she's doing great, but that if she can talk through her contractions, it's probably better to have a bath and go to bed. Even though I educate all my ladies about how not to use timing contractions as a reliable tool for diagnosing labour progress on its own, it is so pounded into our over-thinky, information obsessed, numbers loving brains, it is a very hard concept to let go of. We are terrified our babies will fall out of us unwittingly at home or en route if we don't keep track. Many first time parents are so afraid of not making it the hospital on time. While very fast birth is possible even for a first time mom, the VAST majority of women go to the hospital too early as opposed to too late.

Let's also stop to consider those whose contractions never get closer together than 5 or 6 minutes. I have seen this happen many times. I'm sure some of you experienced midwives and doulas have seen the occasional woman start out with frequent contractions that go on for awhile, and then it's only when they get farther apart the contractions strengthen enough for the cervix to start doing most of its work. For some ladies, if you wait until contractions are five minutes apart, they're going to birth unassisted (which is not the worst thing in the world for most women..but remember, I work with a mostly hospital birthing population who are very attached, understandably, to being in their chosen place of birth).

Instead of looking at the clock, observe the woman. Listen to her. If a dad calls me and announces the contractions are matching some formulaic expectation and I can hear the mom chatting excitedly and barely cracking a sweat during the contraction, I tell them to stay home if they can. Very often they'll call me hours later, and even though the contractions may or may not be different in terms of length and frequency, I'll hear a change. She will be vocalizing in some way, or doing some very focused breathing...her voice will sound a little far away even between the contractions. If I'm present and watching her, her motions will be slower, and more deliberate. She'll have to lean over things and sway her hips. When labour is really rocking and rolling, most women will look quite stoned between their contractions, the idea of distracting themselves by conversing or watching tv ridiculous, and there is a sense they are far away, off in labour land, and moving normally is often difficult. Plus it's aparent they are feeling some spectacularly strong sensations. For first time mothers, this is usually the time to go to the hospital, because labour has had a chance to establish itself...endorphins and oxytocin are flowing beautifully. If a woman goes to the hospital too much before this happens, it can be EXTREMELY difficult to achieve this trance-like state with all the routines and strangers asking questions, often making the labour seem longer and more painful.

At home is where the woman usually finds her power, and is able to bring it to the hospital with her. Labour usually reaches a pivotal point and becomes a little less sensitive to petering out with the initial hospital admitting routine, though some women are very sensitive, and their hormone groove is easily disrupted. But in my experience, women who choose to hospital birth because it's where they feel safe and go when they're in really good labour, there may be a little lull upon arrival, but quickly labour revs up even more strongly because now they feel safe and settled (which contributes to the beautiful symphony of birth hormones). This is more reliable when the staff are friendly and respectful, doing their jobs as "invisibly" as possible. It is easier to re-establish labour in most cases than it is to get it going in the first place.

So when you go into labour, resist the compulsion to rely on the clock or trust a "curve". Do not mistrust your own sense of when you need to get going. Even the concept of "regular" contractions is not so reliable on its own. It is NOT absolutely necessary to have regular contractions to birth your baby. Some ladies' labours sneak up on them, it's true, but for first time mothers this is RARE. A woman and her partner will usually know that labour is advancing, without little stopwatches and numbers chicken skratched onto scraps of paper. Things feel faster, seem longer, are obviously more INTENSE. With all the other cues labour has to offer which TELL you, "Folks, get somewhere safe and comfortable for you!" you will understand that observing is more reliable than timing.

Because about 95% of my mothers having subsequent babies with me have fast, natural labours, I tell them to let me know right away when their contractions make them double over and go, "ohhhh yeah, I remember this...this is HARD." Because things often move very quickly from there. And I don't care HOW far apart the contractions are. I had a woman not long ago do with contractions about 8 minutes apart. The hospital didn't want to admit her. She had her baby an hour later. TRUST THE WOMAN!