Rethinking Timing of Contractions During Labor

5-1-1, 4-1-1, 3-1-1....Could be a secret code, but most pregnant women towards the end of their pregnancies know exactly what those numbers mean. Contractions every 5 (4, 3) minutes, one minute long, for at least one hour. 

TIME TO HEAD TO THE HOSPITAL. (Or, call the midwife, even drive to the birth center.)

Birth partners are prepared for the big day by downloading the best contraction timing app. As soon as the first contraction hits, they excitedly pull out the iPad, or smartphone, and......wait for the next one.

"TELL ME WHEN YOU FEEL ANOTHER ONE!"
        "DID IT START YET?"
              "Oh no, I forgot to hit the button..."
                    "How long are they SUPPOSED to be?"
                          ..........and so on.


You might have an idea where I'm going with this. In, "Your Hormones Are Your Helpers", Sarah Buckley draws a comparison between the labor of a cat and that of her human companion. While the human mother packs a bag and anxiously waits for contractions, the cat searches for a comfortable, peaceful, often dark, place to have her babies. Usually she does not have her babies until she is undisturbed, sometimes frustrating the would-be "helpers". In fact, the cat knows how to give birth instinctively with the hormonal processes that she is designed with. 


AND SO DO HUMAN MOTHERS. But first a little bit of background information...


Many women learn in childbirth education classes or from friends that oxytocin is the "love hormone", at least partially responsible for beginning the birth process and helping contractions to progressively dilate the cervix and help to move the baby down. They may also be told that Pitocin is exactly the same as oxytocin. It is chemically the same, however oxytocin is produced by the mother's body, along with other hormones in an amazing feedback system between the baby and the mother. In contrast, pitocin is pumped into the mother at a constant and steady pace, with no possible feedback based on how the baby is doing, or how the mother is feeling. This is a VERY IMPORTANT difference.


Especially in early labor, the body's production of oxytocin is a delicate operation that can easily be reduced or even halted by adrenaline. Known as the "fight-or-flight" hormone, adrenaline basically works in opposition to oxytocin, although levels DO increase during the second stage of labor, during pushing. This is why waiting until labor is very well-established can help to keep labor from stalling once you actually leave your home if you are planning on giving birth somewhere else. 


SO.....Why ditch the contraction timer?


Because before transition and pushing, a mother desiring a birth with minimal interventions should focus on minimizing the feelings of being "watched", on a clock, meeting a deadline, or having to be on someone else's schedule, to optimize production of oxytocin.


Have you ever had a paper to turn in, or a work assignment due in just a few hours, and you KNOW that it will be completed, but you just don't know HOW by the deadline? Maybe you start sweating, feel shaky, nervous, your mouth feels dry, and you feel "flighty". Maybe if you could just forget about the whole thing it would just go away.


That's adrenaline. And labor doesn't work well under those circumstances. It's not designed to. Although the contraction timer might seem like a fun way to "track" labor progress, it might do more harm that good. Focusing on making sure the contraction timer is being stopped and started and tracked just perfectly....it brings the focus to the mechanical and not the physiological processes of labor. After all, the most "effective" labor contraction is ONE THAT IS WORKING to make the birth process progress.


It does not HAVE to be LONG.
It does not HAVE to be PAINFUL.
It does not HAVE to be VERY FREQUENT. 


It might be all of those things, but then again, maybe not! There are NO RULES in labor, because we are all unique. 


For instance, in my own first labor I was having contractions every 6 minutes, but with a very mild one in between. My books assured me that I was still in early labor, especially since I had only been having them for a few hours. A few minutes later my contractions were 2 minutes apart, and 1.5 hours later, after some pushing, a lot of belligerent refusals to get in the car, and barely making it to the hospital, my daughter was born! 


However, it's also possible to be having strong, frequent contractions, and for labor to be progressing slowly. This is okay! Often in this circumstance women will have to focus quite a bit during contractions, but will not have on their "serious face". Once transition gets close, a woman's facial expression will usually change to one of intense concentration and focus. She also may become more opinionated and "bossy". This is a great sign!


LOOK FOR THE SERIOUS FACE, not the clock face.


Suggestions for laboring women:

• When contractions begin, remember the cat. Find a comfy, happy spot, or continue doing light activities that relax you. Lots of activity is not necessary.
  
• Instead of timing every contraction, glance at a clock every so often just to see if they are regular, until you're sure that they are. Then forget about it.
  
• Consider leaving for your birth place of choosing when you have your "serious" face on. When you feel like closing your eyes and focusing intensely on the process and you feel that you want to change your location. (If you have already had a baby, maybe a little bit before this).

Suggestions for birth partners:

• When contractions begin, remember the cat! Try not to focus on every contraction, the time between them, asking questions about how difficult or not they are. 
• Carry on as usual. Ask your partner how you can make them comfortable, and offer food and drink. Otherwise, help to create a safe space. 
• Speaking or asking questions during contractions, especially as labor progresses, is not usually helpful or recommended. Wait until it's over. 
• Look for the "serious face". Remind her that she is awesome and you are happy to be there with her. Look for changes in activity that suggest that labor is progressing (more focusing during contractions, more comfort measures needed, less talking by the mother even after contractions) and try to use those as a gauge as to when to leave.
• If you really want to use the timer, try to do it silently. Start and stop the timer by what you are seeing. This may be less "accurate", but since the timing is not a perfect science, it really doesn't matter!

As usual, I'm not a medical provider. If you really want to time contractions, go for it! But remember that timing is less important than how you feel! The mother is the only one who can express how she is feeling during labor. Mothers, listen to your intuition, and your baby. Partners, listen to the mother!


Did you have an "unusual" contraction pattern during your labor?