Revised 1/2/13 - I wanted to give a quick revision to this post since it's been a while since I wrote it. I just wanted to reiterate that my purpose for writing such a post is to give information and encouragement to moms on what is a normal variation to labor patterns. My purpose is not to diagnose or provide medical advice. I am speaking in much more general descriptives and know that every situation is different. Every mom and baby has different needs and desires and I also don't want to convey that intervention should never happen in these labors, simply that many times it isn't medically necessary just because the labor is prodromal in nature. I truly value each family's situation as unique and their emotional, psychological and medical needs are not one-size-fits all. I encourage readers to pursue open communication with their health care providers for their particular situation and to assess what is going on with you all personally. I am glad to provide some encouragement to women as they encounter navigating this prodromal pattern in a very charts-numbers-and-clocks oriented maternity system. Prodromal labor is difficult to navigate by its nature, and even more so when it is not a well understood variation, so I don't make light of the experience. I do hope you find encouragement and some useful information here.
Have you ever heard the someone say, "trust me, you will know when you're in labor." But what about when you don't actually "know" it's the real thing until you are going through transition or you baby's head is crowning? Feel like a bimbo? Please don't. This is not some episode of "I Didn't Know I was Pregnant." These women who "don't know for sure" whether or not they are in "real" labor are not bimbos, they are not needing to be better at "tuning into their bodies." They may very well be experiencing a pattern referred to as prodromal labor. It happens. And it is normal for many women.
So what is it? Well, like most every thing in labor and birth, prodromal labor is not black and white. In fact, I'd like to think it is one of those types of labor that really puts our patience, trust and faith in the birth process to the test. It may be defined and described in very different ways by different people. So, let's just highlight some general characteristics that may comprise a woman's prodromal labor experience.
Many womens' labors will not even remotely reflect textbook progression, and I am not just talking about numbers in terms of hours of labor, or rates of cervical dilation. The actual patten of prodromal labor is very different than what many women may experience in so-called textbook labors: "I started contractions early one morning and had my baby in arms X number of hours/a day later". This description is not always characteristic of prodromal labor. Prodromal labor can be a slow, often inconsistent climb toward the hour of birth. In these labors, women may have start and stop contractions for days or even weeks. Laboring for a full day and then contractions petering out...even for a full day or more. Sometimes the contractions are strong, consistently close together and can at times be difficult, even in the pre and early labor stages. Other times the contractions may be manageable, but may last for days and weeks, and perhaps subsequently pick up pace with a rapid sprint to the hour of birth. Some women may very well start off early labor with closely-spaced, strong contractions, bowel clearing, backache, cervical pressure, only to have these things peter out a few hours later and return again...and leave and return and so on. There are so many patterns within patterns in the variation of prodromal labor, so each woman will describe her experience a little differently. Prodromal labor may not be hours or days of continuous active-labor-intensity levels (though this also can occur at intermittent times during prodromal labors). Commonly, these labors can be physically wearing and mentally difficult. They may affect sleep and activities of daily living. On the other hand, these labors may also have some perks. More on that later. There is a lot that seems unknown during a prodromal labor.
What is certain is that *ALL* the work, all the contractions count toward the final moments in labor and birth of the baby. And don't let anyone convince a woman those hours and days "don't count." Should how much or how little a woman's cervix is dilated at any given time during labor really be what determines whether she is in "real" labor or not? I personally don't think so. I find that criteria a very narrow way of looking at labor and birth. Truly, in the big picture, even braxton hicks at 20 weeks still count toward the final moments of birth. A woman's body is still doing the physical conditioning that will strengthen her for the birth of her baby.
So, am I just describing a drawn out early pre- and early-labor phases? Well, not necessarily. One of the things about prodromal labor is that it can be very illusive in its pattern. It may follow the signs of early active labor for hours and then, suddenly stop or go dormant for a long period of time. For one example, let's say a woman begins by having contractions that are already several minutes apart and moderate in intensity and this lasts for 5 hours and then, for whatever reason, labor seems to stop. A few mild contractions may continue here and there, much like what is often experienced in the final weeks of pregnancy anyway. But what seemed like active labor 'getting going,' seems to just as suddenly dissipate. Labor may in fact be taking a break, even for hours and days with very few contractions during those dormant phases. And then these might pick up again, suddenly and try to keep a woman on her toes thinking she is about to transition very soon. Of course, this is only one description of one pattern -- prodromal labor (like other labor patterns) just basically does what it wants.
Now, when a woman tells you she was in labor for 5 days, you might wonder if she is being dramatic. Perhaps she is. What is likely more descriptive of the woman with prodromal labor is that she labored off and on for 5 days. If she were to count up the hours of labor spurts (those periods of notable, consistent contractions) that may wax and wane, and add them together, she is likely to give more context to this labor description than just '5 days of labor.' Perhaps its just me, but using a simple, non-contextualized statement of 'labored for 5 days' conjures up in my mind a woman heaving and bellowing and moaning for 5 days straight with strong, intense and painful contractions. Probably not. Likely there is much waxing and waning during those days. That being said, some women may have consistent, closely-spaced contractions for hours on hours into days, but often in these prodromal patterns, the pain intensity and strength of contractions is more manageable, and at some point closer to the final period of labor, moves into those strong, intense contractions. Just examples. Indeed despite the mental and physical challenges of prodromal labor, there may also be those potential prodromal labor benefits I mentioned earlier.
Imagine running a marathon. In this race, you are not being ranked according to how few hours you take to complete your race. Instead of having a hard, pounding race to the finish line to fit it into a determined record of time, you are able to sprint for several miles and then walk for a couple, sprint for several more, walk. Unfortunetely you don't know what the mile markers are in this marathon and you may or may not be able to actually sit down at least not for very long. You have to just keep moving forward and hoping that the banners and flags will start to appear before you lose your sanity, but you get breaks from intense running too. Although you may not be having to run as hard and fast as some of the other participants, you may also not able to get much rest. Just as you are getting ready to take a break for a while, suddenly, you are required to start sprinting again. No nap for you:). Good thing you were able to walk slowly that last mile. Let's say it takes you 4 days before you finally cross that glorious finish line. It is still an incredibly physically challenging event, moreover it is an especially mentally challenging event. Yes, you had to do that race drawn out over many days and without a sense of how far you had traveled and how far you had yet to go. But it was a slower climb too. You completed it, no matter how choppy it seemed, it was still well done. Remember, pre- and early-labor are just as important in the whole process of birth as are those hours of hard active labor, transition and pushing. The first 7 miles of a marathon ALWAYS count toward the 26.2 total distance. You may not be running till your heart bursts all those hours, but you are still moving forward toward your final reward.
This description may be in contrast to a precipitous birth -- you know the kind that might start with whammo, intense, transition-style contractions and an hour or two or three later a baby is born. Incredibly challenging, perhaps very scary, disorienting and overwhelming, but start to finish, comparatively quick. These are simply different patterns. Precipitous has its pros and cons, just as does the more "average" type consistently progressive labors, as also does prodromal labor. I can think of reasons why a woman would prefer each respective pattern and reasons why they may not prefer each one.
Perhaps the most difficult part of prodromal labor can be mental and emotional...the idea of not knowing just how to "trust your body" because your body is sending mixed signals. Many women may feel the first hours of contractions (which still may be close together and last consistently for hours) and start calling their family and their provider and excitedly head off the to hospital only to be told "you're not in labor" or "you are not far enough progressed to admit to the facility." (By the way, consider it a blessing if the staff sends you home to labor--though it may be frustrating, it may spare you many unnecessary interventions and it may give you the chance to be patient and most especially to try to get sleep and rest when you can, which can be more feasible at home versus a hospital. Thanks to protocol, in the hospital you are on the clock). "Not in labor?!" Well, that's not really true, but if you define everything narrowly by textbook, than I see how that conclusion can be reached. Problem is 'textbook labor' is supposed to simply be a description, not a diagnosis. She may very well BE in labor...this may be a labor with intermittent patterns and start-stop progress that just isn't fitting into the numbers protocol. This is defeating and frustrating for expectant families to hear.
Even as defeating as this may be, there is a more concerning possibility. If a woman is not encouraged to go home to labor (or for home births, if the midwife does not encourage the woman to give the process time), providers, or facility protocol, or frustrated parents may start pushing for interventions to "get things going." In their excitement, and in their mindset, labor is supposed to be progressing this certain way and it is not obeying the preconceived laws! Inductions, augmentation, vigorous walking, herbs, more pain meds, IV fluids, and other labor stimulating tricks may all be applied in a succession of battle-like efforts. It may be more the provider pushing for these things, it may be more facility protocol putting pressure on the labor progress, or it may be the family who pushes for the mortar attacks. Problem is, in addition to exposing a woman and her baby to the side effects of (quite possibly) unnecessary interventions, this mindset betrays a lack of trust in the birth process and a lack of awareness in the vast variations of normal labor patterns. And what may very well happen after all these tricks are said and done, (some perhaps having been effective, often, many have not) a laboring woman approaches the transition and pushing phase....completed exhausted. And exhaustion in those last minutes and hours of labor is not a favorable situation. It can also potentially lead to the need for more serious interventions and at best, it is not a kind think to do to a birthing woman (or for a woman to do to herself).
The temptation to intervene is strong in these labors. But the most vital needs are tincture of time, support, sleep, rest, food & fluids, loads of patience and faith. The management of a prodromal labor is often not permitted to be directed by normal physiology, but instead subjected to outside influences. Perhaps more commonly in a hospital birth versus birth center or home settings, prodromal labors are more likely to be mislabeled as "failure to progress." Although this circus of events may be more common in a hospital setting, there is no less potential for it in a birth center or home setting. The interventions themselves may be different in type, but they are still interventions. Nonetheless, even if the interventions themselves are different at a birth center or hospital, the mindset may still be the problem. There may not be epidurals placed or IV fluids or pitocin administered at the birth center or home. But there may indeed be prescriptions for vigorous walks, calisthenics, herbs, supplements, teas, tinctures, sex, etc, etc. The root of biased expectations still may remain the problem -- the birth process is not being trusted. [Of course as a reminder, we are not talking about labors wherein there is fetal distress or threats to health and safety. We are talking about labors that simply stand in contrast to the expectations for what a "normal" labor pattern is "supposed" to look like. But perhaps it is our expectations and not the labor that need refreshing, intervening and education.] There is a dance of provider personality, experience, protocol and expectations along with the dance of the laboring family's personality, experience and expectations. It may not be a pushy provider that leads to a high intervention prodromal labor, it may very well be impatient, anxious or under-informed parents. Or the parents may indeed be both well-informed and patient, but are being cared for by an impatient, anxious or aggressive provider. Or still, it may be the pressures put on both the family and the provider and staff due to rigid undiscerning protocols or the facility.
Before we get too far off track, this is not a discussion on which kind of intervention is more safe or effective versus another. It is a discussion of not needing the intervention in the first place. But more importantly, it is a discussion of having wise expectations and seeking congruity in our perspective - Do we truly trust the birth process or not? Many women wonder if the interventions they had pushed on them (or they themselves requested) were possibly unnecessary. Perhaps they didn't cause notable harm, which is not an insignificant relief, but again, our discussion here isn't about when interventions are more helpful than harmful -- it is about expanding our expectations for what are normal variations in labor patterns.
*Although I respect many of the physicians, midwives and birth professionals who attempt to define prodromal labor, I personally feel that most descriptions (even from typically low-intervention oriented providers, many home birth midwives included) are at best too textbook, some narrow-minded, and some even inaccurate. In fact, some providers and birth professionals deny that prodromal labor even exists and may lump it into the very condescending phrase "false labor." I think that unawareness or limited knowledge among women and providers' descriptions is because the majority of descriptions are being written from the perspective of an outsider, usually a birth attendant. And even a wonderful birth attendant is not with the laboring woman for the entire start to finish process of labor.* So, when you read definitions of prodromal labor, consider they may likely be too black and white....Why is it so important to me how prodromal labor is described? Self-disclosure, I've enjoyed one such labor personally. And that story I will save for another day.
"Interesting perhaps, but all of this didn't really tell me what prodromal labor was all about." Well, prodromal labor may not necessarily fit into a dictionary definition, sorry to irritate you after reading my droning. So, instead of worrying about how prodromal labor is defined, learn what prodromal labor is like as an experience. Hear from the perspective of mothers who have experienced it or perceptive (and non black and white-thinking) providers and support persons who have been with these women. Below are a few links to prodromal labor descriptions as told by mothers, and some birth professionals.
If you have prodromal labor stories you'd be willing to share or links to other stories, please let me know. I'd love to continue adding to the growing stories. A few women in the birth community have made it their special interest to educate the rest of the community on this normal labor variation.
A special thanks to Sarah for her example and resources.
Read about prodromal birth stories:
- Sarah's collection of stories and descriptions of prodromal labor: http://www.nmfrogblog.blogspot.com/
- "Red Light, Green Light: A Tale of Prodromal Labor":
