ASKAugustine - Why Labor Stalls? (a conversation between a student midwife and an experienced midwife)

Augustine: Hi, Welcome back.

This is Sneha. Sneha is a physical therapist, and prenatal educator, childbirth educator and a Doula. And she's also a midwifery student. And I get to work with her. And we are at a birth right now. And she had a great question. So I just thought we'd hop on and chat about it.

So we were talking about why can labor stall? Or why can labor arrest? So let's brainstorm some reasons. 

Sneha: First, I think is just to give her some rest.

Augustine: Sure her body might need rest.

Sneha: Recouping the energy. 

Augustine: So there could be a plateau. Right, which would be that she is resting recouping energy, that she has a break and contraction patterns. But plateaus are not usually random. They're usually caused by something. So what could cause a labour to plateau?

Sneha: Is that the position of the baby?

Augustine: Could be position of the baby. What else?

Sneha: Can the uterus be tired for a while? 

Augustine: Yes, we can have actual maternal fatigue, maternal exhaustion, or we can have uterine inefficient contraction, uncoordinated contractions. Yes, or actual fatigue. Yes, yeah. What else?

Sneha: Is it something like she's trying to hold on to something that will play because she is.

Augustine: Yeah, it could be psychological. 

Sneha: Yes, it is.

Augustine: Like emotional arrest or emotional dystocia, essentially, and it can cause a lack of…or it can cause a pulling back from the sensation where she needs a break or she needs space. 

Augustine: So emotional dystocia is sometimes caused because of fear. Sometimes caused because of stress, because when we have adrenaline rush circulating in our body, adrenaline is the neutral… neutralizes oxytocin. You know this. And so that fight or flight response can cause a pause. Certainly fatigue, lack of calories, dehydration, right? But the most common reason why babies are in funky positions, or the baby is in funky positions are what caused an arrest. So do we think that maybe this baby rotated into the posterior? 

Sneha: Can we check it? 

Augustine: We could. But let's think through what the benefit is.

We already know she doesn't love exams. 

Sneha: Yeah, that would mean that a prolonged labor? The posterior?

Augustine: It could make a prolonged labor. So we have a, we have already had rupture. And we have a primip, who doesn't really like exams, it's uncomfortable. So we want to avoid as much as possible, but not avoid to the point where we then have no clue, or have to transport because we missed a time to intervene to keep it normal, right? I think at this hour we're okay. But I think as we get closer to evening, we do need to have a plan to go into the evening. And I think we could use the natural “midwives get up and go” the “midwives Pitocin”, which is basically breast pumping? 

Sneha: Yes. 

Augustine: Because it releases a bunch of hormones. 

Sneha: Nipple stim.

Augustine: Exactly. It causes the contractions. And we could use some herbs or homeopathy. 

Sneha: So what kind of herbs would you recommend? 

Augustine: Well, I was gonna ask you, what do you recommend?

Sneha: We have not been using the herbs.

Augustine: Oh you haven’t? Okay. Well, I know predominantly North American herbs. So I'm not sure that that is a good choice here. Homeopathy is very common here though, it's a traditional medicine here. 

Sneha: Yeah. 

Augustine: And I do have a big homeopathy kit. So we could utilize that. That feels more like in alignment with this community. 

Sneha: Something like pulsatilla?

Augustine: Pulsatilla could work. Pulsatilla is like the windflower, riight? So Pulsatilla is sometimes stage fright. Sometimes in coordinate contractions, sometimes mal-positioning, it can affect all of those, so that would be a good option. 

I also love gelsimium. It can be a tremendous remedy for the cervix.

And then obviously calophyllum and cimicifuga are really traditional labor prep or labor encouragement homeopathy, and they're the homeopathic preparations of blue and black cohosh. 

Hypericum has also been helpful to me before we could use that.

She has been having this gas issues and carbo veg kind of speaks to me about that because carbo veg is that heavy, full, gassy, bloated kind of feeling is carbo veg so we could do that. " This would be a good time to review Homeopathy for Childbirth Course by Mette Mitchell on Midwifery Wisdom School.

Sneha: Acupressure points actually would work. 

Augustine: That would be a great idea. Do you have familiarity.

Sneha: Yes.

Augustine: High-five girlfriend!

Sneha: It has worked, really well for me. 

Augustine: Yes! I agree acupressure can be hugely helpful either. 

Sneha: So either we can do nipple stim, nipple stimulation right now or maybe the acupressure because both of them would have been strong?

Augustine: Or both?

Sneha: No?

Augustine: No, I think both would be okay. Why not?

Sneha: Okay.

Augustine: So where, what acupuncture points do you like to use?

Sneha: Pinky toes. 

Augustine: Pinky toes. Bladder 67.

Sneha: And I use this or maybe this at times.

Augustine: I love that. Yeah. All right. Let's try it. See what happens. We have a mama at six, who's probably had a bit of an arrest of progress. She's… her connections have spaced out. And yeah, prom. 

Sneha: Yeah, but she's energetic. 

Augustine: She is energetic. Yeah, she's been taking rest and activity, rest and activity. 

So we are 36 hours post rupture?

Sneha: Yes. 

Augustine: So, we’re thirty-six hours post rupture. And we are doing prophylactic GBS antibiotics and hopeful that we can have a baby by tonight. Fingers crossed.

Sneha: Fingers crossed.