All first timers labor for three days.

We live in a society of impatience. Virtually everything is immediate gratification. We have instant communication, instant information, and instant entertainment. We are used to a very fast pace of living, even when we live modestly. We can order things online that once were beyond our ability to purchase, now they arrive within days at our doorstep. We can click a button to instantly be connected to friends on social media. We can share photo and conversations in real time.

When it comes to birth, we are often still caught in this same trap. We want immediate information, clear signs, predictable patterns. And I think sometimes the birth fairies just laugh at us.

For a first time mama, birth happens differently. We so often, especially in our society, and it's levels of expectation, forget that birth happens best with patience. It is certainly NOT a simple event. We try to place simple measurements of progress on the processes of birth and we find ourselves disappointed. No wonder, for birth is complex and yet simple. Just consider some of the things that must happen in order for baby to make the sacred journey earthside: mother's hormone balance has to be just perfect; proper nutrition, hydration and rest must be balanced, for the body knows exactly how much of each it needs to actually progress forward in labor; baby engages and applies pressure on the cervix; the cervix must move forward from behind the babies head (posterior) and align itself optimally to receive pressure in "all the right places" for progress; the cervix has to soften from perhaps 4 cm thick down to paper thin (what other part of your body does that?!); then it must open so far that it completely dissolves and nothing is left in the vaginal canal except the babies head (full dilation); simultaneously the baby is navigating its way through several layers of several different muscles running in just about every direction called "the pelvic floor" it's called a floor for a reason-it holds up quite a bit when a woman is not pregnant, and it requires quite a lot of navigating--and opening to admit a baby clear I could go further on and in much greater detail, but lets just stick with that information for now.

For the first time mama, everything is different. Her pelvic floor is still virgin. It has never been navigated by a tiny new being before. Hormones have not had to balance as they do now, her cervix has never gone the places it has gone and has never changed in the way it is about to change!

But, her body in all it's wisdom knows what to do, and all she must do is teach her mind, to trust the process.

One of the first things I began to notice as a new Midwife with extra sharp attentive senses, was that labor is NOT a fast process! Oh sure, some mama's deliver is rapid speed of a few short hours, you may even get a shockingly fast delivery (the record for shortest labor in my practice is 22 minutes start to finish) but the reality is most people talk about "labor" as what we call "active labor". Active labor is when the contractions are steady and close (less than 10 min apart-usually more like 5 min apart) and strong and the mother is opening, baby's descending, birth will be happening soon, everything is progressing. But "labor" happens for weeks. It starts with Braxton Hicks (which I call "toning contractions" from here on). The toning contractions start working the uterus out for the big day of active labor, they keep it fit and firm, they help push baby down and around and into an optimal position. Mother's begin to get up several times a night to urinate, and often have insomnia, she may have loose bowels, she gets emotional, she is tender and soft and cries readily. These are all signs of hormonal shifting. Some days before active labor she may have appetite changes-craving carbs, and exhaustion-requiring sleep in heavy doses during the day. She may stir and organize and then reorganize. These are all activities and signs of preparatory work being done in the body.

In my experience I typically see: first time mama's will begin to contract one night close to the end of their time (perhaps even a week past "due").  The contractions are mild yet strong enough they arouse her from sleep. She has a few that are 15 minutes apart and she can no longer lay in bed. She gets up, often to urinate and then stays up. She feels excited, for her labor pains have begun and she is going to welcome her baby soon! She stirs, she organizes, she sets things up, she preps, she maybe even wakes her partner and puts her team on alert. Several hours go by, and perhaps he contractions work down to 8, 7 or even 6 minutes apart. They lengthen from 20 seconds to 30, 45 and the intensity rises to the most she has ever felt. She begins to tune in to her body, perhaps practicing with precision her skills learned in birthing class. Her partner is up with her, bringing drinks, rubbing her back, timing and supporting, doing the part...and time slips by. Soon the sun begins to peak in through the windows, she is sleepy and floppy, perhaps even dosing off between contractions. Her partner is exhausted from being up all night and they begin to wonder what's wrong. Why isn't it getting stronger and longer? Why are they "losing their labor" that went all night?

This is typically when I get a phone call. It usually has some urgency. They want to know what just happened, why they are exhausted, where the baby is...and where the labor is going. Mostly these precious parents want their baby that is lingering at their fingertips and they want to know how to keep things going. Should they walk? Have sex? Take herbs or oils?

They are almost always astonished when I say "go to sleep." And when you, drink, laugh, play and then go back to sleep!

The next night guess what happens? The same thing! (This is when many hospital birthing families may go in, get checked, be under 3 cm dilation, told to walk and be rechecked, there's no progress so they are sent home, tired and frustrated at "false labor")  And so I get another, even more exasperated call the following morning. The partner's missing work, the babys not coming, the mother feels desperate pressure to move this labor forward and "please, what can we do?"

Go to sleep, I say. And when you, drink, laugh, play and go back to sleep!

The third night...things begin again...and this time they move steadily forward. My phone rings several hours before dawn and it's time to go attend a birth.

There is so much happening in those first two nights of labor. (And it's almost always night-that's when the lovely birth hormone oxytocin rises and peaks, slowly fading as the sun comes up and stops the contractions.) All those wonderful things are taking place in the body during those first two nights of work: hormone balancing, cervical position is adjusting, cervix is thinning under baby's head which is pushing down with each strong contraction, baby is twisting and navigating-often in millimeter amounts that make all the difference in the world for progressing labor--and then finally the part that sometimes seems to be all anyone cares about--dilation! Slowly the cervix opens and baby emerges, one inch forward half and inch back, stretching the muscle and tissue as it goes. It all seems so slow and teasing to the first time parents. It's hard work and demands patience. Much like that new little bundle will!

I've learned to tell my first time parents to expect this pattern. Them knowing and planning for this pattern saves me and them a lot of missed sleep and unnecessary worry and work!  They know to update me as any changes occur, but that they will likely not need me until the third night. (And if it happens on night two or by some chance night one, then all the better!) First time parents in my practice know partner will miss a few days of work for labor work, they stock up on food--snacks and meals--as well as electrolyte drinks to stay hydrated and fueled up during those nights of work. They often put black out curtains up or plan to make daytime sleep easier. (which is all the better to prepare for a newborn in the house shifting all grasp of time reality anyway) They plan movies, games and activities.

Sometimes I still get called on that first night. Sometimes it's really hard to tell if it's time or not, mamas frantic and hurting and so I go. I get there and check and she's about 2-3cm, but her head tells her she is 7cm. We have a conversation about all the work that's happening, discouragement is the enemy here. I want her to hold hope, but also understand this is a long process and she needs her endurance. She must understand that although this is the most she has ever felt, this is very early labor. Any amount of exhaustion, dehydration and low fuel will cause hypersensitivity and make early labor work feel like strong active labor. I explain that she could soon be in active labor, or she could do this pattern a few nights. A soft reassuring conversation often brings the release of tears and relief. She's emotionally reset. A snack and warm milk, dimming lights and soft massage often will settle mama into bed with confidence to sleep in between and through everything she feels.

I tiptoe my way out and wait for the call in the morning.

This is the first of many practices of patience and endurance that come with parenting. A good support person will observe these patterns and find ways to educate their families and encourage them through this process that they can look back with confidence and empowerment--which are excellent things to have when going into parenthood that will serve them for years to come!

Happy Birthing!


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