Is Pitocin the ONLY solution if we experience a labor stall, or a pause in labor progress??
No. It is a possible solution, BUT NOT the only solution!
First, we need to understand what is causing the labor stall. Then we can address the issue to see labor progress.
In some situations, Pitocin is the best solution to the labor stall. In other situations, we may need to address baby’s position, create more space in the pelvis, or release tension in the pelvic floor.
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In the meantime, let’s explore different causes and more solutions for labor stall beyond just Pitocin!
1. Is this actually a stall? For a labor arrest or stall to be “for real,” then dilation, effacement, AND station will NOT be changing for a period of time. If any one of those is still changing, then this is not a labor stall.
2. If it is actually a stall, then we need to consider the 3Ps: the passage, the passenger, and the power, to understand where we may need to address to prompt labor to resume.
The Three Causes and Solutions for Labor Stalls
There are three main causes of labor stalls that all can be addressed in slightly different ways. Pauses in labor can be normal, as labor may ebb and flow based on our needs.
Sometimes our body intuitively understands that we need more rest, so it slows our contractions to give us an opportunity to rest.
The three main causes of labor stalls could include:
- The passage, or the physical structure that your baby needs to navigate through during birth
- The passenger, or baby’s position as they fit through the pelvis
- The power, or the strength of the contractions which relates to you!
In some situations, Pitocin could help increase the strength and frequency of contractions so that we see labor progress.
In other situations, such as the passage or passenger, we may want to first address baby’s position or the decreased space in the pelvic level before we introduce Pitocin.
1. The Passage: The Pelvis + Pelvic Floor
There are three main things that influence the passage:
- The Pelvis (bony structure)
- The Pelvic Floor (muscular floor of the pelvis)
- Uterine Ligaments
Usually, with the passage, we need to focus on creating space and releasing tension to allow baby to navigate the space.
The Pelvis: Creating Space
The shape and space available in the pelvis determine the passage, and if baby can then fit through this space.
Fortunately, the pelvis is highly mobile during pregnancy and birth, and there are movement patterns that open and create more space at the various levels of the pelvis.
Opening the Pelvis to Resolve a Labor Stall
If the passage is the issue, we can first address decreased movement or space in the pelvic level that baby is currently at.
- If baby is in the inlet, then we want to create more space at the top of the pelvis with external rotation of the femurs (wide knees) and pelvic tilting.
- If baby is in the midpelvis, we want to create more space in the middle of the pelvis with side-to-side or asymmetrical type movements.
- If baby is the outlet, or we are pushing for a long time, it could be that we need to create space in the lower midplevis. We can do this by focusing on one-sided internal rotation of the femur.
Learn more about the biomechanics of the pelvis in our online, self-paced childbirth education courses and birth workers course.
The Pelvic Floor: Release the Tension
The pelvic floor also plays a large role in the passage! Baby has to navigate through the pelvic floor on their journey through the pelvis.
The pelvic floor can play a huge role in your baby’s head positioning, which can either support or slow labor progress.
If the pelvic floor is slowing or stalling labor progress, it could be due to uneven tension in the pelvic floor. This could cause baby’s head to tilt sideways and not press evenly against the cervix.
We can focus on releasing this uneven tension in the pelvic floor in a variety of positions depending on mobility.
The side-lying breathing drill is a pelvic floor release exercise that can be done both with and without an epidural during labor. Focus on driving the top leg BACK so that we create a closed hip position. Then inhale down to feel the pelvic floor stretch. Exhale to release.
Watch the breakdown video for more information.
Learn to relax the pelvic floor in our pelvic floor prep for birth course! In this self-paced, online course, we break down HOW to approach preparing your pelvic floor for birth with educational videos on pelvic floor anatomy, function, and birth prep. This course includes thoracic and pelvic mobility exercises, breathing drills, and pelvic floor relaxation exercises to prepare your pelvic floor for birth!
The Uterine Ligaments: Release the Tension
The uterine shape also influences HOW baby can position themselves. You may start to notice that the passage plays a large role in how baby (the passenger) can position themselves.
The uterus is attached to the pelvis by uterine ligaments, which can sometimes have uneven tension. This uneven tension could cause the uterus to torque or have “speed bumps” inhibiting baby’s ability to rotate or descend into the pelvis.
We can release tension in those uterine ligaments during pregnancy (to try to prevent stalls) and during labor if we do experience a stall.
During pregnancy and labor, we can focus on releasing the tension in those uterine ligaments with inversions, forward leaning postures, belly lifts, and releasing the posterior pelvic floor.
Watch the breakdown video for more information.
2. The Passenger: The Baby
The way the baby is attempting to descend and rotate through the pelvis can influence their relative size and ease of descent. If we find that the labor stall is related to baby’s position, we can focus on trying to help baby find a more optimal position with movement.
If baby is in a less optimal position and already engaged or attempting to engage, we can use inversions to help baby back out of the pelvis and then reposition.
In addition, if baby’s head is tilted or deflex/extended, it could also be inhibiting labor progress! An inversion can encourage baby to adjust their head position.
We can do a number of inversions, depending on our mobility, to help adjust baby’s position or head position!
If we have an epidural, opening the pelvic level and Trendelenburg the bed may be the best type of inversion.
If we have a lot of movement, an open knee-chest inversion that we hold for 20-30 minutes may be the best option!
An open-knee chest is a great option if you do not have consistent or close contractions!
This can help baby fix their head positioning (deflexion or extend to a flexed head position) and potentially adjust to a more optimal position!
3. The Power: The Contractions
The power of our contractions is influenced by our hormones. The release of these hormones may rely on us, as the person giving birth.
We release more oxytocin, which would make our contractions stronger and more powerful, when we feel safe and supported.
If we feel afraid or fearful, our release of oxytocin may be inhibited, which would interfere with the strength of our contractions.
Power Solutions:
This is where Pitocin could be helpful! If the strength of contractions is the issue, then Pitocin can increase the strength so that we may see labor progress.
But, if someone is wanting to avoid or limit Pitocin during their birth for whatever reason, we may want to explore other solutions, such as:
- Eating or drinking fluids
- Resting (if you can’t rest, an epidural could be a great option)
- Sometimes a warm bath can help with rest too!
- Fear release exercises
Labor Stalls: Understand the Cause to Find the Solution
A labor stall is defined by all three measurements of labor progress (dilation, effacement, and station) no longer changing.
If there is a stall, consider the 3Ps: passage, passenger, and power. Which is these is contributing towards a potential stall? Then consider a plan of action to address the source of the stall, and then you may find that labor suddenly resumes.
We break down labor stalls and solutions with anatomy & biomechanics in mind in our labor biomechanics webinar and childbirth education courses.