Understand and value the ‘latent’ phase of labour.

If we are to believe Hollywood (we don’t..) then labour takes about 6 minutes and birth about 2 minutes (it doesn’t..). I do not think that movies actually influence our perception of real life THAT much (seriously: Nicole Kidman aged 23 cast as a neurosurgeon. Really, Tom Cruise, we are gullible but not morons). However, there is a persisting belief that labour takes about 8 hours, ramps up really quickly and only starts when you don’t feel tired. Let’s have a bit of a reality check.

Often you hear women tell of their ‘3 day labour’ or ‘50 hour’ labour. They either tell you because 1. they wear it as a badge of honour (they endured so much..) or 2. they are horrified they were allow to labour for so long (surely the hospital is negligent..). In the eyes of maternity services providers, we know that most of that time is ‘latent phase’. Painful? Sure. Exhausting? Extremely. Traumatic? Often. Natural? Absolutely.

Here is what you need to know:

• Labour, especially the first one, takes a lot longer than you think.
• Women having their first labour and women having their subsequent labours are like 2 different species. Their labours are completely and utterly different. Latent phase is usually MUCH faster in subsequent labours.
• Labour does not always start and increase predictably; it can come and go.
• Labour can start just as your head hits the pillow and sometimes you will not sleep for 1, 2 or 3 nights in a row (apart from brief spells of 1-2 hours or lots of micro-sleeps).

I say all this not to frighten women. It is just the TRUTH*. Labour is a lottery. The best guide you have to predict your own labour is to know your own mother’s labour and birth history.
(*not just my version of the truth, Megs and Haz. THE truth.)

The hospital system does not support the natural progress of labour. Hospitals only want women to present when they are in ‘active’ labour. What does ‘active phase’ mean? You will learn in classes that there is a 1st, 2nd and 3rd stage of labour. The 1st stage is further broken down into the ‘latent’ phase and an ‘active’ phase of labour. The active phase is when the contractions are regular, predictable and moderately strong. It tends to progress in a linear fashion (the cervix dilates about 1.2cm per hour in first timers, 2cm per hour in following births). Labour is considered by medical staff to be active when the cervix has reached 4cm. However, that is all very mathematical. It can occur much more quickly, or more slowly, and can be linear or exponential in terms of the progress. Hospitals use a ‘partogram’ to depict this progress in a diagram. Whatevs. You can’t measure magic.

I think the problem is that we under-value the latent phase. The hospital system doesn’t provide time or space for women in latent phase.

Yet it is the most CRUCIAL phase (in my opinion).

What good is the latent phase?

• It ‘sets the scene’ for the progress in the active phase.
• It’s purpose of the latent phase is to slowly nudge the baby’s head into the pelvis.
• It helps the head rotate into the correct ‘anterior’ position: the position that is so crucial for the best fit into the pelvis.
• The slow increase in the frequency of the contractions (from every 10-15 mins to every 5 minutes) as well as the slow increase in the strength of the contractions allows a woman to ‘acclimatise’ to the labour. Humans are more likely to cope with pain when it builds up rather than being slammed with pain quickly.

The reason hospitals don’t support latent phase is that they provide staff according to ‘medical need’. Women in latent phase don’t have much medical need. They need rest, simple pain relief, reassurance. And time. Unlimited time.

Latent phase can take one hour or 40 hours. Contractions can come and build up. Or they last a few hours then stop. Then come back. This early ‘dance’ with labour is frustrating because women don’t know how long they will need to endure it. There is no ‘end in sight’. They worry because they don’t know if what is happening is ‘normal’. They look for reassurance. They ring the hospital. Multiple times. They are reassured that all is well but by the 3rd phone call they are invited in to be seen. They are tired and have had enough. If they are still only 1-2cm dilated on examination they are deflated and throw in the towel. They acquiesce to intervention- induction, epidurals. Now, BE CLEAR! I am NOT judging those women. I do not think induction or epidurals are bad. The desire to stay under supervision, to have stronger pain relief, to want things to move more quickly, to get some bloody sleep (!) are all completely understandable and appropriate. My issue is that women do not EXPECT latent phase to take a long time. They are not expecting or willing to be patient. They do not expect to be exhausted. They do not expect the extent of the pain that labour brings. They do not expect to have absolutely no idea that we cannot tell them how long it will take to get into ‘active’ labour. All we know is that it will eventually happen and to try to be patient until it gets established.

The absolutely brilliant thing that courses such as Calmbirth and Hypnobirth offers, is education about not being frightened of latent phase. To be patient. To be calm. To use alternative, non-medical means to cope with the long and frustrating and seemingly endless irregular contractions. They teach how to trust that your body is doing the right thing. It knows what it is doing. The use of terminology such as ‘surges’ rather than contractions is to help reduce the fear associated with the contractions = pain. ‘Natural birth’ courses teach patience and faith in your own body. That is gold. It is just qualified, by the fact that all the patience and faith in the world will not guarantee a ‘natural’ birth or a safe birth. It goes a LONG WAY, however.

Women are often reluctant to stay at home. What keeps them from staying at home?
Pain.
Sleep deprivation.
Fear.

How do medical people respond to those factors?
Give pain relief. Strong enough to allow sleep. Keep women in hospital help them feel safe.

The problem is that all these things can interfere with the ‘natural’ progress of the latent phase: the scene-setting phase.
You can’t put on a play or bake a cake or sit an exam or have a ‘natural’ labour without doing the preparation. Allowing latent phase to progress naturally will maximise the chance of the best positioning of the baby and the best conditioning of the cervix and uterus prior to the ‘main event’.

Now, of course, sometimes all the scene-setting in the world cannot guarantee an uncomplicated active phase or uncomplicated birth.

• There is no point staying at home if the baby’s health is compromised.
• There is no point in enduring latent phase if a woman is in agony, miserable or terrified.
• If latent phase is taking a long time, a check-up in hospital is appropriate.
• To be reassured that everything is normal.
• To check the baby is coping with the labour by doing a CTG (graphing the baby’s heart beat).
• To give some pain relief.
• To diagnose a problem or provide certainty or relief by way of induction or augmentation of labour to shorten the process.
• To arrange stronger analgesia such as epidural to allow relief of suffering and allow a woman to sleep.

So my tips are these:

• Have good quality antenatal care to ensure both mother and baby are in the best possible condition before labour even begins.
• Be mentally and physically prepared for the latent phase.
• Do not expect it to have a predictable time-frame. (Active phase is MUCH more predictable).
• Take simple pain relief (ie paracetamol) or have something stronger from your doctor (ie paracetamol with some codeine) to help ‘ease’ you into the discomfort of contractions and allow some rest between.
• By all means stay in touch with the birth-suite and report anything you are not sure about.
• Be prepared to come in for assessment and then,
• BE PREPARED TO GO HOME AGAIN. Sometimes the best thing you can do is have a check up for reassurance then go home again if the labour is not yet established. The actual dilation of the cervix is not as important as the nature of the contractions and the ‘descent’ of the head into the pelvis.

Personally, my philosophy is that women can give birth ANY WAY THEY WANT.
Your body.
Your choice.
Ideally, that means making a rational decision about both mode of birth and understanding the processes involved. That also means knowing the pros and cons of each.
It also means doing everything you can to minimise the risk of COMPLICATIONS that put mother and baby at risk.
If your plan is to have a VAGINAL birth, regardless of whether you are planning for ‘uber-natural’ or ‘elective epidural’ style birth, then embracing the latent phase will certainly reduce the risks of complications in labour and birth.

Often you read that having an epidural increases complications such as need for synthetic oxytocin drip or assisted birth. I do not believe that. It does, however, if you have the epidural TOO EARLY. By entering the active phase with a baby in the best possible position then even if you choose an epidural it will not slow your labour. Quite the opposite. It often speeds it up. The pelvic floor relaxes and, as the head is already in a good position, the fetal head can just ‘drop into place’ and descends into the pelvis perfectly with resulting rapid cervical dilatation. I believe it does not increase the risk of assisted birth providing a woman can have a bit of rest to re-charge, then have constructive guidance to push effectively and plenty of time to do so (up to 3 hours but usually baby is born within 1 hour of effective pushing).

So,
Have faith in your body.
Get some pain relief.
Get in the bath.
And be patient.