Labor Stalls
If labor begins to stall or seems to be pausing temporarily (or it may feel like forever), there are a few things we should consider.
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 of 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!
The Passage: The Pelvis + Pelvic Floor
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.
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.
Learn to relax the pelvic floor in our pelvic floor prep for birth course!
If there is a stall, consider if there is enough space for the baby to descend and rotate through the pelvis. This factor considers the physical space that the pelvic can create with movement to allow the baby to descend through.
Movement is key here!
If we are not moving, then there is no change in the amount of space available at each level of the pelvis. This may result in relative CPD, or when the baby presents larger than they actually are.
We can address a stall related the passage by increasing movement that opens the level of the pelvis that baby is currently at (their station). When we create more space at the appropriate level, we may find that our progress suddenly resumes!
Learn more about the biomechanics of the pelvis in our online, self-paced childbirth education courses andbirth workers course.
Signs the passage is the potential cause of a stall:
- Holding continual tension with contractions; fighting contractions
- Inability to relax or release
- Uneven sensation of contractions; all one sided, more pressure on the left versus the right
- Lack of movement
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.
If baby is tilted, we can use a similar technique, but also accompany it with pelvic floor relaxation.
Sometimes if baby’s head is tilted, the uneven tension in the pelvic floor can cause the baby’s head to tilt sideways. Breathing into our pelvic floor may help to release this tension.
Signs that baby’s position is the potential cause of a stall:
- Contraction pattern is irregular, such as double peaking, doubling with a long break in between every 2-3 contractions.
- Uneven sensation of the contraction, such as feeling it ALL in the back or only towards one side.
- Cervical exam assessing baby’s position
- External palpations assessing baby’s position
- Belly shape indicating baby’s position
We break down more in-depth positioning techniques in our birth worker’s course.
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 birthing person.
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.
What are some considerations if power of the contraction is the reason for a labor stall?
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Feeling safe and supported? Does the birthing person feel that they are supported by the team around them? Does the birthing person feel safe with the team around them? Is there an underlying or unspoken fear that is haunting the birthing person, such as a fear of birth or a fear of a transition? When we address this, we may find that labor resumes!
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Consider observing who is on the birth support team, and either increase the presence of those that are positive contributors and removing those that may be creating a negative impact.
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Increase loving touch, such as massage, kissing, or hugging.
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Do a fear release to acknowledge the fears, validate the concern, and then develop a plan of action to overcome them. Sometimes a good cry is all that is needed for labor to resume.
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Is the mother sick? The health of the birthing person may influence how well the uterus can work and diminish the power of the contractions. Can we address the sickness to help labor resume, or do we need to consider alternative courses of action, such as augmentation?
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What are the energy levels? The uterus is a muscle, and muscles need recovery and nourishment to function properly. This is especially true for endurance events such as labor! When was the last time the mother slept or ate something?
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Can the mother find rest? Either restful laboring positions, or maybe an epidural is a good tool to utilize to find some restful sleep finally. If an epidural is utilized, consider allowing the mother to actually rest uninterrupted for a few hours.
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Can the mother eat or drink something for nourishment? This is more than jello cups and juice. We may need actual food and electrolyte beverages to find a replenishment of nourishment and energy.
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.