Active Labor?

This is a curious phrase.. Active Labor…

When you ask moms when their labors started it is funny when they think they were in active labor. Some think it is when their water broke although it was not accompanied by contractions. Others think it was when they felt the first contraction- but others would say they had felt contractions for days before they were regular. Some would say it was when they began to have to concentrate and work during their labors.

Recently I had a mom who was contracting regularly and working with many of the contractions- having to concentrate and stay focused. But her cervix was not changing at all. The doctor came in and did an exam and said that active labor was, “when you are contracting regularly and it is making a change to your cervix.” This mom was not happy when he said she was not yet in “active labor” as she felt she was working hard already. He in fact suggested she either go home or allow him to get her in active labor by either breaking her water or starting Pitocin.

Recently I had a mom who entered the hospital at the direction of the nurse at her doctors office since she had a list of regular contractions on a piece of paper documenting her labor. She was chatty and her demeanor was light and engaging. She entered the hospital and the nurse even said she was probably going to go home as she did not appear to be in labor. But the doctor came over to check her and found her to be 3-4 centimeters dilated. He said she was in “active labor” and they would be keeping her at the hospital.

Now often times we hear stories of women who walked around 3-4 centimeter or even more for weeks- obviously not in “active labor” but definitely contracting some and making changes in their cervix. But this mom stayed at the hospital and over several hours her contractions came in a gentle but irregular fashion and never made any change to her cervix. They even discussed going home but did not do so. Eventually the doctor broke her water and her labor became active.

Women are confused when they go in and hear differing opinions- do I go home? Am I in active labor? If I am not in active labor, how will I know when I am if this is not it? Is this a dysfunctional labor or is this not really labor at all? Is this prodromal labor or early labor?

I wish I could offer a definitive answer. The truth is no one really knows. Moms have had babies in the car or at home when their labor patterns were so irregular everyone listening to their dialogue of what is happening said- it is too early to come in. And moms have sounded like they were in active labor on the phone with their care providers only to get to the hospital and be told they were 1cm dilated.

Labor and labor patterns remain a mystery. For care providers to say it must be regular and painful to be active labor is proven every now and then to not be so. And for care providers to push a woman into active labor when her body is warming up but not quite ready may not be fair either. In fact so much of a woman’s labor pattern has been misunderstood today because so many labors are not allowed to unfold naturally- they are so over managed by intervention that normal, natural labor is being lost.

Here is what others define “active labor” as:
Birthing Naturally says, “Eventually, the contractions that you have been experiencing will become stronger and more intense. You will also find that as time progresses the contractions are getting closer together and lasting longer. When this happens, you will have moved into active labor. You will find that as active labor progresses, you will become more serious or “focused” during your contractions. You may find yourself slowly moving from not talking during the peak of a contraction – to not talking during a contraction – to barely talking even between contractions. You may also find that your movements become slower and more deliberate as you progress through active labor. Eventually you may even be at the point that moving between contractions is uncomfortable and difficult to manage.”

Baby Center says, “During active labor, your cervix begins to dilate more rapidly and contractions are longer, stronger, and closer together. People often refer to the last part of active labor as “transition.”

Transition to Parenthood says, “What’s happening: Cervix is completely effaced, goes from 4-8 cm dilation. Contractions 3-5 minutes apart, lasting 40-70 seconds. Contractions become more painful. Duration: 30 minutes to 10 hours. The physician’s expectation for progress during this time is 1 cm dilation per hour; if you’re dilating at less than half that rate, a physician may prescribe Pitocin.
However, a recent study indicates that at non-augmented births, the average / normal amount of time between 4 cm and 10 cm is 7½ hours, and that abnormal progress shouldn’t be declared unless it has taken over 19½ hours for first-time moms (that’s less than 1 cm for every three hours). Abnormal progress shouldn’t be declared until 13½ hours for a woman who has given birth before. (Albers) If mom is doing fine, and baby is doing fine, then parents can ask the caregiver whether Pitocin is essential or whether it is possible to let labor proceed at its own pace.
Mom’s Mood. One of the biggest indicators that active labor has begun is a big change in mom’s mood: she becomes much more serious. During a contraction, the contraction takes all of her energy and concentration: she can’t walk and talk during a contraction. She doesn’t like distractions in between contractions; just wants to focus on labor. This can be a good time to go to the hospital.”

Women Heath Care Topics shares, “Active labor is characterized by three distinct phases:* Stage One – The cervix dilates and effaces, * Stage Two – The baby is born
* Stage Three – The placenta is delivered.

Giving Birth Naturally offers, “Active labor is when birthing becomes more serious. As you become more serious with each contraction, relaxation and breathing become very important. Tuning out distraction and creating a positive environment will be important. You may feel the desire to have your birth companion present but may not want to be touched or bothered at this point. WHAT & HOW YOU MAY FEEL:
* Contractions that are Closer Together and Require Your Attention
* Need for Physical Support
* Need for Emotional Support
* Less Interest in Eating/Drinking
* Desire for Quiet so You can Focus
BEHAVIOR & ATTITUDE:
* Turning Inward
* More Focused
* Averse to Distractions
* Restlessness
OTHER SIGNS & SYMPTOMS:
* Bloody Show
* Diarrhea
* Rupture of Membranes
* Increased Pressure
* Lightening
* Nausea”

So you can see it can be confusing. It is not the same for every woman. It is not easily defined. I share what someone once told me- “You know she is in active labor by her demeanor. The meaner she gets the more active she is in labor!”

I tell my students three things will happen: The contractions get longer- lasting more than a full minute. The contractions get closer together- not all over the place but a regular pattern that is closer together. If you plan to get medication then 511 is a good time to go- five minutes apart, lasting one minute for at least one hour. If you are looking for a less interventive birth experience, then 411 is a better time to go. But all three things need to be in play USUALLY. If you are talking through contractions, laughing and walking around easily and they are 3 minutes apart, you may not be in active labor. If they are 6 minutes apart but lasting 90 seconds and are kicking your butt, you could be. See? This is confusing at best!

So guess what? You need to be the judge! If you think it is time to call your care provider to come to the house for your home birth, or go to the hospital for your birth- then go. You do not have to stay! The studies show if you go to the hospital and you are 3cm or less and your water is intact, you should go home. Otherwise you are at a 50% increase of having a surgical birth- why? Because you are probably not in active labor and the care provider will push your labor to get you there- by breaking your water or adding Pitocin to the situation to help “move you along.” And if your body or baby is not ready- well then you may end up with a cesarean.

If you are wondering, “Is this the real deal?” it probably is not. Most moms will tell you, you will know when it is the real deal.