The MamasteFit Podcast Episode 122 – Labor Stalls: Aligning Baby and Pelvis for a Smooth Delivery

Gina: Welcome to The MamasteFit Podcast. In this episode, we’re going to be talking all about labor stalls, specific to what should you do if your baby is having a hard time navigating through your pelvis. So it could be related to your baby’s position and how they are moving through their pelvis, or it could be related to their path, or their actual structure that they’re trying to navigate through. We’re going to discuss what is a labor stall and how you can know that you’re having a labor stall related to those two issues, plus some ways that you can resolve it.

Welcome to The MamasteFit Podcast. In this episode, we’re going to be talking all about labor stalls related to your baby, and your pelvis, and the path that your baby is navigating through. And it’s important to note that with the pelvis, it’s not just bony structure, there’s also muscles and ligaments and organs that your baby is navigating through. And so we’re going to break down, one, what is a labor stall? Two, how do you know that you’re having a labor stall related to those things? And, some ways that we can resolve it.

So first, Roxanne, what is a labor stall?

Roxanne: So a labor stall is when your labor either stops progressing or it slows down. So either your contractions stayed the same but your dilation, effacement, or station of your baby is not changing as well as your temperament is not changing, or your contractions now are starting to space out. So maybe there were two to three minutes and now they’re like five to six minutes apart, not as strong. And then again, the dilation and your temperament has not changed as well. Because the three different things we’re looking for with labor progress are: how is your temperament changing throughout your labor, what are your contractions doing (are they getting closer together, more intense?), And then, obviously, what is your cervix doing? But I think the temperament and the contractions are usually more of a better indicator of how your labor is progressing.

Gina: It’s important to note that labor is not this like linear path, either. It can ebb and flow, increase in intensity, decrease in intensity based on your individual needs. And so it’s not, once contractions begins it just literally increases in intensity until your baby’s born- there can be some flowing with it as you navigate through phases, as you shift from place to place. So like when you go from home to your birth location it can vary depending on who’s in your space, how you’re feeling, and so again, it’s not just a straight line of progress. There could be some wiggle room here and there as you go. But the main things to look for: is your temperament starting to shift, are your contractions getting closer together, are they increasing intensity, and then, is there some change happening to your cervix?

I agree where I find that your contraction intensity and your temperament are probably like my best guesses on how things are going. You don’t always need to know what is going on with somebody’s cervix to assess their labor progress, mostly because your cervix is not a crystal ball. It doesn’t predict really anything. It’s not going to tell me that your baby’s going to be born in 35 minutes, it’s not going to tell me if your baby’s going to be born in eight hours, like it’s just really a moment in time, and things can really shift very quickly with cervical change, or very slowly with cervical change, and it doesn’t necessarily equate to an issue. So paying attention to your temperament. Is it changing? Are you going from being a little bit more present within your environment to in your own little world? Maybe things feel a little bit more chaotic and confusing for you, and then all of a sudden you feel a stronger urge to push. So that’s a pretty clear progression that labor is going along the lines that it wants. And then your contraction intensity, do they feel more intense than before? Does the sensation feel different than before? Are they closer together? Are they lasting a little bit longer? So these are all like external signs that we can look at to determine that labor is progressing well.

And I also find that like inside you know that things are going good. You’re like, “Things are progressing. It might be slower than I would like, I would’ve liked to already be done with this,” but inside you can know, you could probably feel like things are normal, things are progressing well, or something’s off, something’s going on.

So the first type of labor stall you can have is related to your baby’s position. So if your baby is not well aligned to the pelvic level that they’re trying to navigate through, they’re going to have a little bit harder time fitting. And so your body’s going to be working really hard to help them rotate so that they align better. And so I like to use the analogy of your baby’s a square peg and your pelvis is a square hole, and so they’re meant to fit with one another. But if you slightly aligned the square to be more like a diamond and you try to ram it into your square hole, it’s not going to quite fit. But once we can rotate and turn it, then it just slides right in super easily- like obviously “easy” is a relative term when it comes to labor. And so if your baby is not well aligned to the pelvic level they’re at, they may have a harder time moving through the pelvis and this can cause a little bit of a stall, and then bodies can work hard to rotate.

The other thing that can happen is your baby’s head could be slightly tilted. Maybe their head is not in this good chin tuck position where they present much smaller, and so if your chin is to your chest, that very top crown of your head is what is going to be presenting, and the diameter or the circumference of that, is much smaller than if your head is looking forward, or even if you’re extended in your neck. Like that’s going to be much bigger. Or if your head is tilted, that circumference is much bigger than that chin tucked, so baby can present larger if their head is not in a really great position.

And so with the both of those things, the body’s going to work harder to try to rotate. But it doesn’t want to do too much and overwhelm the baby, and so it’ll do like a burst of effort and then a bigger break, and then a burst of effort, and then a bigger break. So you may have something called like a coupling of contractions or doubling, or like even double peaking contractions where you have one contraction, it comes down and then you have another contraction almost immediately, and then five minutes break. And then you have two contractions and like a big break, or two or three contractions, like back to back, and then a big break. So that’s a clue to me that baby’s position is a little bit off.

Something else that I usually look for, is I’ll ask my doula clients, “How does the peak of the contraction feel? Do you feel like it’s one smooth peak, where it comes up at peaks and then releases? Or do you feel like it comes up at peaks, releases and then peaks again before it really lets go?” So like double peaking contractions, or sometimes I’ll refer to them as like bumpy contractions. This is usually a clue to me that baby’s position might be a little bit off and your body is trying to help them move.

Something else that I’ll also really notice if babies are maybe a little bit in a funky position, is you may feel contractions a little bit more like one sided, like you feel a little bit more sensation to one hip versus the other, and you’re also favoring like a lot of really tucky positions, like you’re trying to create more space to help them have more room to rotate, are like things that I’m like looking for as signs that maybe baby’s position’s a little bit off. So if I’m noticing those external signs that maybe baby’s position is a little bit off, in addition to things don’t seem like they’re progressing, this is where more of that collaborative care can be really helpful. So like me as a doula, I’m limited on the tools that I have because I can’t really do hands-on assessment. I’m not doing a cervical exam in somebody, I’m not palpating their belly to feel their baby’s position, I’m not pulling an ultrasound out.

What are some ways, Roxanne, that we could integrate the medical team to help us understand what baby’s position is, to help us figure out, okay, they’re positioned like this, so these are the movements that we should try, or these are some tools that we can use to help support their position.

Roxanne: So there are tons of different things that you can use to assess the baby’s position. If you want to stay like external, you can palpate the belly to feel where is baby facing, and then try to see are they extended in their head or are they, tucked or are they more of a neutral position based off of what their like head is doing in the pelvis. And this is all done with palpation of the belly, but not every provider is super confident or super familiar with doing external belly palpations to assess like what the baby is actually doing within the pelvis. And sometimes babies, like, their bodies could be a little bit bonier or like just feel differently than other babies ’cause they’re all individual like humans, so sometimes our assessment externally can also be wrong. Like it’s not 100%, even though I like, I would like to think I’m 100%, I’m one not 100% at assessing a baby’s position of what their head is doing as well as the rest of their body.

So the other option, if it’s available, is an ultrasound. Like you can do an ultrasound to see where is the baby facing and is their head extended. But that’s also limited depending on how well engaged the baby is ’cause they can’t see what baby is doing, like beyond the bones. So if your baby is like super engaged into your pubic bone and like in your pelvis, like the ultrasound just cannot reach there.

Gina: I had a hard time at the end of my pregnancies when I was trying to get like a picture of my baby and it’s like…

Roxanne: “Here’s her neck!”

Gina: “Here’s your pubic bone, and a smushed baby.”

Roxanne: Yeah.

Gina: So I can sympathize with if baby is well engaged the ultrasound is a little bit more challenging.

Roxanne: It’s just not effective at seeing through bone. And we’re not going to do an ultrasound, I mean, we’re not going to do an x-ray because that’s just not ethical and not necessary in any sort of way.

So the other option that I find is a little bit easier to figure out, and then if you have the ultrasound, use the ultrasound as like a confirmation, is using an internal assessment. So you do a vaginal exam and at the top of baby’s heads are like skull bones, they’re all fused together so like you can’t feel like the suture lines of your skull as an adult, but a baby, those suture lines are not fully fused yet because they have to adjust based off of the space that’s available within the pelvis to be able to fit. So we feel for those suture lines on the baby, as well as the little soft spots, for lack of better word. In the front of the head the soft spot is a different shape than the back of the head, so the front is more of a diamond where the back is more of a triangle and we want to feel a triangle ideally, because that means the baby, his chin is tucked and that’s what we’re feeling is the back of the head where that triangle is, as well as all of the suture lines coming off of it.

If we feel the triangle, but it’s more to the right or to the left, and then that suture line is also more to the right or to the left, that’s also telling us that baby is tucked, but it’s probably coming down what we would call asynclitic, or “catty wampus” is another one that someone calls it, but baby’s head is pretty much just tilted. And this can be a good thing and a normal thing that some babies do to just fit into the pelvis, but if they can’t re-straighten their head back out once they’re in the pelvis, then it could be become an issue. If I feel the diamond, that means that your baby is not tucked and either in a neutral position or more extended depending on where within the vagina, I feel that triangle, so through the vagina, I feel the diamond. So in those cases, that’s when we would probably try to adjust based off of what the baby is doing, where they’re facing, what position we would want to try to encourage them to go into to create the most space so that baby can then reposition themselves, usually first starting with an inversion.

Gina: Let’s take a break from this week’s episode to hear about our podcast sponsor, Needed. Needed is a nutrition company that specializes in optimizing nourishment for the perinatal timeframe, and is a brand that Roxanne and I have personally utilized during our pregnancies and now into our postpartums. And you can use our code MAMASTEPOD to get 20% off your order.

One of my favorite things about Needed is that you can a la carte based on what you’re needing. And so they have their standard prenatal vitamin, which is much more than just a standard prenatal vitamin.

Roxanne: Very comprehensive.

Gina: They’ve done a lot of research on it, and they have actually done some clinical research trials to demonstrate the effectiveness and how amazing their prenatal vitamin is. But we don’t want to put everything that you need in one vitamin, ’cause some of these supplements may interact with one another and how well you could absorb it. And so Needed has some of these supplements separate based on what you may individually need. And one of the things that we added on to our prenatal vitamin, but we took it a separate time, was Needed’s iron.

Roxanne: A very common condition that can develop during pregnancy is anemia and specifically iron deficiency anemia. And so not all of us need an iron supplement during pregnancy, but the few of us that do need an iron supplement during pregnancy because of our iron deficiency anemia- such as us, with our low iron levels- it can be beneficial not to take it with your prenatal because of some of the, like, nutrients within a prenatal vitamin can counteract the ability of your body to absorb the iron, which, if we are taking iron, we would like it to actually do the things that it’s needed to do.

Some other iron supplements that I’ve taken have really led to some constipation and like really upset tummies after taking it. But with Needed’s, I didn’t experience any of those symptoms, so it really encouraged me to continue taking it, whereas before I would stop taking it and just dealt with my anemia.

And I also really like it because based off of your lab values, they tell you how many pills to take. So I was able to discuss with my provider and be like, “Hey, I know I’m anemic. Can we do this level, our ferritin level, to tell me how much iron I actually need to supplement?” Because of Needed’s recommendation on their page, I was like, oh, I need this lab value to tell me. So I really love that Needed has that recommendation on their website.

Gina: During my last pregnancy, I was borderline anemic and I started taking Needed’s iron supplement and within a few weeks my levels had almost doubled, which I was really impressed by and was obviously very happy with as well.

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So there are two areas that babies tend to have more stalls, entering into the pelvis, and then exiting the pelvis, which you might be like, Gina, that’s the whole pelvis.” Like it is, but like those are like the two main areas. Getting engaged, sometimes we could see a stall, and then exiting and finishing the rotation, we can sometimes see a stall. And there’s a little bit different solutions for each of them, and they’re relating both to both baby’s position and the physical structure that they’re passing through. And so they, I find that the passage and the passenger stall are really commingled with one another.

The first thing that we’re going to do in both situations, if your baby’s having a hard time engaging or you have a late labor stall, you’re like eight centimeters, or you’ve been pushing for forever and they’re just not rotating, is we’re going to try to invert. The reason being is this sometimes brings baby to a space where they have a little bit more wiggle room, or it just gives them a little bit of anti-gravity so they can sometimes just adjust their head position- and sometimes that’s all you need. Sometimes just a little puppy pose for one contraction and you feel a shift and then your baby’s falling outta your body. No promises, but I have had that happen where all we really needed was for baby to adjust their head position, they tucked and then they just flew through the pelvis. And that’s a really common thing that could occur.

So the first thing we’re going to try is some sort of inversion where your hips are higher than your head. You could do it on the bed, you can be on two different levels where you have your arms on a lower surface than your knees, so that would be like a forward leaning inversion, a little bit more intense of an inversion. You could do more of a puppy pose where your knees and arms are on the same level. So it’s essentially a much more relaxed inversion, but sometimes it’s really all you need. If you have an epidural, you can tilt the bed, you can Trendellenburg it. Usually you’re going to need your nurse and provider support for that one, I would not recommend partners trying to like, tilt the bed themselves. So you can do that, you can tilt the bed to sometimes help baby adjust their head position. So those are kinda like the main inversion options that we can use to see if that’s enough. Does that cause things to shift for you? And that’s how you’re going to know that your stall is resolved, things change where you’re like, things are different now, the pressure feels different. I feel more pressure. Things are, my contractions are closer together, they feel stronger. There’s just going to be some sort of like shift that happens.

If you do your inversions and you’re like, “Feels the same. I don’t know if that was it. I don’t, I think I need more,” if your baby’s having a hard time entering into the pelvis, we want to help them rotate so they can then align to the inlet and enter into it. And we’re going to do this with more open hip position, so we can do like- with the belly down- so like a tabletop position where you have one leg on a peanut ball and a fire hydrant. That’s going to help rotate baby a little bit more towards the front. If you cannot get into a tabletop position, you can also do like exaggerated side lying where your leg is up on the peanut ball. And for those of you’re listening to the audio only, know that in the show notes we’re going to link a video where we talk about addressing labor stalls, where we’re showing you all these different motions. And in the podcast video we’ll have some overlay of images of this is what that position looks like, ’cause sometimes it’s a little confusing.

So after we do like a fire hydrant or an open hip position, so essentially like knee is away from the belly and belly’s a little bit more towards the floor- probably hold that for 20 to 30 minutes. We’re then going to move to a little bit more of an upright position. So ideally what has happened is we did the inversion, baby adjusted their head position. We then did an upper mid pelvis opener with our open hip position, belly to the floor, so they ideally rotated to align to the inlet. And then we’re going to shift upwards, so baby can drop into the pelvis. And you could either do like an elevated lunge with an open hip position, you could do like a deep squat. If you’re in the bed, you can do like a throne position. So there’s so many different movement options that you could do to help baby just drop into the pelvis. And then hopefully we feel a shift, something has changed that can happen.

Other things that we can add in for releases- so let’s say the passage is the issue, there’s movement restriction along the way. We can think about releasing the lat musculature, we can think about releasing the hip flexors, ’cause sometimes those two muscles are a little bit tight and it’s pulling the pelvis into one specific position, making it hard to have good pelvic and rib and spine mobility. So if we release those two muscles, sometimes that could help things really shift to allow baby to enter into the pelvis. We can also do like some belly sifting or massaging like of the belly to release tension in the uterine ligaments, that can sometimes help with babies dropping down into the pelvis. You can also do jiggling, which I think feels really good, it is so nice, where you literally are just shaking your booty with the hands.

Roxanne: Jiggling.

Gina: So you’re not like twerking.

Roxanne: “Shaking” seems excessive.

Gina: Somebody is placing their hands against your butt and like shaking, and that is like really relaxing, I don’t know why. I mean, know why, it’s stimulating the fascial layers, which releases endorphins, but it feels really good. It looks super silly, but it feels really good. So, we can try some release techniques such as releasing the lats and the hip flexors to improve pelvic mobility, we can release muscularly or in like the tension by doing some belly sifting, belly massage, jiggling of the legs or the glutes, and hopefully that has all helped your baby really drop into the pelvis.

If baby’s still having a hard time entering into the pelvis, we can do the quote unquote “magic moves,” and we have a whole podcast episode where we talk about the magic moves of labor and we have a YouTube video where we break down this position, which is called Walchers. So Walchers is where your legs are essentially hanging off the end of the bed, and that position really brings you into a little bit more of an arched position that is changing the pubic bone angle and sometimes can really help babies drop into the pelvis. And so this is one of those moves where if it’s going to work, it’s going to like work really well, and so this will be like a last resort type of thing. It’s really uncomfortable to be in, I would not say If your baby’s having a hard time engaging, do it right away, ’cause it’s not comfortable to be in. But we have an entire podcast episode where we talk about these magic moves and the nuances of them, and a YouTube video where we break down Walchers as well, if you are curious about it.

The next area that babies sometimes have issues moving through is the pelvic outlet or the lower mid pelvis, so babies have a hard time finishing that rotation to get underneath the pubic bone. This typically happens at eight centimeters, or if you’ve been pushing, you’re pushing for a really long time, and it’s like, and just like peekaboo with you, which is the worst. And so with this late labor stall, we’re trying to create more space in the lower mid pelvis to help baby rotate underneath the pubic bone.

So if it’s an engagement issue, we’re trying to create space in the upper mid pelvis to help baby rotate to enter. If it’s a late labor stall, we’re trying to create more space for baby to finish that rotation to extend underneath the pubic bone. And so we can approach it with the same way, where we start with those inversions to see if maybe baby’s head position is just a little bit off and that’s what’s causing the labor stall. And sometimes that’s all we need. Usually I find with the late labor stalls, if the inversion is going to work, this is where it’s more likely going to be, ’cause sometimes it’s just baby’s a little asynclitic, they’re a little tilted. And then once we invert, they tuck and then they just fly out of your body.

After we invert, we can then either do some releases, so releasing in the pelvic floor musculature- either with jiggling again of the booty, just….

Roxanne: The booty jiggles just through all of labor honestly, just never stop shaking the butt.

Gina: Any sort of hip shifted exercise is helping to stretch the pelvic floor musculature. You can try sitting on the toilet and see if that helps to relax your pelvic floor. And you can also do like a sacrotuberous massage, where it’s like in between your tailbone and your sitz bone.

Roxanne: Right next to your butt hole.

Gina: There’s this little pocket of ligaments that you can massage and that can sometimes help with sacral mobility. So those would be like a few different release techniques that you can try.

After you do some release techniques, you’ve tried the inversion, you’ve done the releases to help try to create a little bit more space, we can then move into some positions that help to really open up that lower mid pelvis, which are going to be our hip shifts. If you’re unmedicated, you can really do a hip shift anywhere- you can do it standing, you could do it in the bed, you can do it on all fours, it really just depends on like wherever you feel most comfortable. But with the hip shift, what we’re trying to do is rotate the pelvis on the femur so that we feel a little bit more of a stretch in like the hip pocket area. So if you are wearing some jeans and you put your hands in those jeans, you’re feeling is stretch, where one of your hands is a little bit more. And so this is stretching more of the back half of your pelvic floor, which can help to improve how well your sacrum can move and how well you can create space underneath that pubic bone.

So with the hip shift, you can do it standing where you’re really just shifting your weight from leg to leg, bringing the belly a little bit more towards the thigh. You can be in a tabletop position, so this is a great option if you’re in the bed or even if you have an epidural and you can get into a tabletop position. You essentially just shift your weight over towards one knee, bringing that belly more towards that thigh. You can place a pillow underneath the knee, too, so sometimes I’ll just fold a pillow in half and place it underneath the knee just to have a little bit of elevation on that side, and that can help you get into a little bit more of a hip shift. Your partner can do a single knee hip shift for you. And then you can also do something called a side lying release, which is not a hip shift, but it is like a good relaxation exercise as well that does bring the bottom of the pelvis a little bit more open. However, it is not comfortable to be in towards the end of labor when you’re having a late labor stall, so it is another one of those magic moves that I would say is a late, or a last resort type of thing. It wouldn’t be like my first line of action.

Roxanne: Feels very nice during pregnancy.

Gina: It does not feel great during labor.

Roxanne: Does not feel great while having a contraction.

Gina: But similarly, we have a video where we break down the side lying release in addition to those hip shifted exercises that we were talking about, which would be like our first line of… offense? Defense? I don’t know, whatever, whatever the terms would be. So we break down not only the side lying release and what’s happening with it, but also these prerequisite exercises that I would try first to help create more space in the bottom part of the pelvis.

So if your baby’s having a hard time finishing that rotation, you’re near the end of labor, it’s a late labor stall, typically we’re going to start with an inversion to see if maybe baby’s head just a little bit funky, and that’s what’s making it hard. If that’s going to work, it’s going to work really quickly and you’re probably going to start pushing very shortly after that. We can then think about releasing tension in areas, so jiggling, pelvic floor relaxation exercises, massages of the sacrum. We can then move into some movements that create more space in the bottom part of the pelvis and the lower mid pelvis with hip shifted exercises, either standing, all four, a partner supported one. And then our last line of… offense? We’ll figure out what the word would be.

Roxanne: Defense.

Gina: Defense? Last line of, or is it defense? I feel like it’d be offense, ’cause we’re doing something.

Roxanne: But we’re doing something in reaction to something that they’re doing…

Gina: Anyways, whichever it is, my last resort would be like a side lying release would be what I would use to help really see if we can shift things around. But yeah, hopefully with all that, things shift and then your baby’s just like, “All right, fine. I’ll come out, if you insist.”

So the two areas that I commonly see stalls related to baby’s position or to the passage is going to be, they’re having trouble entering into the pelvis, where we’re going to think about invert, release tension to make it easier for the baby to move around, and then we’re going to create space in the upper mid pelvis, so open hip positions. If baby’s having a hard time finishing that rotation underneath the pubic bone, we have a late labor stall or pushing for a while, we’re going to think invert, ’cause maybe their head’s a little bit off, we’re going to think about releasing tension again, mostly in the pelvic floor type area. So if it’s an engagement issue the releasing is typically pelvis and up. We’re releasing up here to improve mobility, to help maybe drop down. If the issue is the lower part of the pelvis, we’re releasing more of the pelvic floor, sacral area to help release tension. And then we’re going to think about closed tip positions and creating space in lower mid pelvis with like hip shifted movements. So those are like our tips for that.

We have a whole PDF guide in our childbirth education course that includes this stuff as well. So if you’re like, “Oh my god, that was a lot to remember,” there is a PDF guide inside our childbirth education course that you can just download and print out if you are in our courses- so you do have to join the course to receive the PDF. but again, I love showing up at births where people have the PDF printed out and they’re just referring to it, ’cause it also includes…

Roxanne: I think one person had like a binder of literally all of them.

Gina: Yeah.

Roxanne: And you would just like (flips pages).

Gina: Because it has what labor positions to do if you’re baby’s here, what to do if you’re having an issue here, and so it’s really nice ’cause they already have all of those tools available for them, and you can too, by joining our online childbirth education course! But we’ll link in the show notes below all our videos that we break down some of these exercises as well, so that you can be more familiar with them.

And then our prenatal fitness programs, this is where a lot of the stuff that we do in our prenatal fitness programs is helping you to ideally avoid labor stalls because we are helping, one, to support baby’s position with our exercises so that it’s easier for them to change positions. We’re releasing tension, we have balance, we’re supporting their head position with different movements, in addition to being able to create space within the pelvis. And so I never want to blame anybody for the stalls or issues that happen during their labors, but if you are more familiar with movement, it’s going to be easier to create the space and it’s going to be easier to do the things to help adjust issues.

And so, if I had to pick one movement to help you prepare for birth, I would encourage you to be really familiar with hip shifting, to learn how to find a closed tip position so that we can create space in the bottom part of the pelvis, ’cause I tend to see more issues here than anywhere else. And our prenatal fitness programs include a lot of exercises to help you create space in all the different parts of your pelvis.

So Roxanne, what is your experience as a medical provider with managing labor stalls? ‘Cause commonly, if somebody’s labor is not progressing, so they don’t have contractions or they’re spacing out, they’re irregular, their temperament is the same and their cervix is doing nothing, do we just give them Pitocin? ‘Cause it sounds like all of the stuff that I was talking about, how we could help baby’s position, how we create more space, did not involve making their contractions stronger.

Roxanne: Yes. So usually in a hospital, and like prior to me, like understanding the like full spectrum of labor, usually the answer was like, “Oh, they’ve been four for the past eight hours, we need to give them Pitocin.” And sometimes, very rarely, but sometimes it truly could be beneficial. If their contractions truly are just not strong enough and baby is in an optimal position for their body, Pitocin could be helpful, in some situations.

But, if the reason for your labor stall is your baby’s position is not optimal for your body, or there is some like tension within the path that baby is navigating through, giving Pitocin is not going to change, likely, the baby’s position. If baby is in an un optimal position for your body and you’re having those contractions where you’re having one or two, like two or three in a row, with a long break, two or three in a row. So we’re never going to Pit through an abnormal contraction pattern. So if you’re having these like back to back contractions with a long break, that is their sign to us that we need to help this baby reposition, not just give them more Pitocin to make these contractions just stronger. That potentially is just jamming this baby that is, like you said, a square hole with a square peg that is like in a diamond shape. Yeah, I’m just going to continue to jam this diamond into this hole and eventually it’s going to fit. But that’s not what’s actually going to happen.

Gina: I mean, my 2-year-old that does it eventually learns, “Oh, if I turn it…”

Roxanne: If I turn it, yeah. But, sometimes, if you just keep jamming it like it could hurt the little square cube. Like that’s basically what’s happening, which means this is going to cause distress for these babies, or we’re just going to like jam this baby into the pelvis in this mal position, to a space that they don’t have as much room to reposition themselves, which then could lead to a C-section because that baby can’t reposition themselves or come out of the pelvis.

So Pitocin should never be our first line if someone is having a stall. We need to figure out what is causing the stall, and if it is truly baby’s position, we need to fix the position to be more optimal, like repositioning them, or if there’s like tension within the pelvic floor, help them address like by releasing those tensions. But that’s not always taught to people in hospital settings or in residencies. “Hey, there’s three reasons that someone can have a labor stall, these, this and this. These are the solutions that we can do before going to Pitocin.” Sometimes yes, like the baby could be in a funky position, then we fix the position, but that still doesn’t lead to stronger contractions. And then, yeah, maybe in that point Pitocin could be helpful if, in whatever instance that is. But if we don’t fix the position or the reason for the stall before adding in interventions, then this is just increasing, and leading to, that cascade of interventions that everyone talks about in hospital settings.

So if anyone ever, like when we are doing our vaginal exams, if we check one and they’re the same that they were four hours ago, this is when the problem solving begins of, “Hey, is this just their normal pattern- ’cause everyone progresses normally throughout their labor- or, what is this baby doing? Let me see what this baby’s doing within the pelvis.” ‘Cause they get a say in how they come out as well. They gotta shimmy through, that takes a lot of effort for them! And then what is like the pelvis feeling like? Like what is going on with their pelvic floor and their body? Have they been in this one position for four hours and have not moved? Let’s move, maybe. Let’s create, give the motion, give the body some lotion with some motion, so this baby can come out! And sometimes, literally that’s all we need to, do is literally just move them from the position that they’ve been laying in for four hours. Especially with an epidural, we want to still be repositioning them, but if it’s been four hours and you have not, oh, it’s shocking how if you just position them to the other side, that labor progresses.

Gina: So this feels a little bit like the chicken and the egg kind of conversation for me where for me, before my first labor, I was very anxious about Pitocin, like it was something that was really scary for me. And so I think that there are a lot of people who hold very similar fears about Pitocin. There’s a lot of negative kind of commentary about Pitocin, like, “You should never get it.” But, on the other hand, it also is overused.

Roxanne: Yeah.

Gina: And so it makes sense that there is this fear of Pitocin when it’s really overused and being used in scenarios where like in theory, like you would think that makes sense, but like in reality it doesn’t.

And so Pitocin is a tool that’s available to us. I think understanding that there are a lot of people who are fearful of it, for good reason, too, because it is overused, is important to maybe encourage providers and medical teams to consider, “What other options do we have before Pitocin? Because it could, this could help my patient feel more confident and comfortable.”

Roxanne: Yeah.

Gina: So that they know we tried other stuff before we made it to Pitocin. Or, if I’m noticing the signs are more related to the strength of the contractions, then Pitocin can maybe be an option. We’re going to do a whole mini episode on power stalls, which are a little bit different than the passenger and passage stalls.

So there is, one, the fear with Pitocin that I think is very prevalent. I think that there’s good reason that people are scared of it, it is overused, but it is a tool that’s not bad or evil. There are good times to use it. And so not jumping to it right away is probably going to help your patients to be more comfortable and confident in your care that you’re just not doing stuff, ’cause it’s easy- because giving Pitocin…

Roxanne: Super easy.

Gina: …is easy, compared to, “Let’s get into these positions.” ‘Cause like the story that I’m painting in my head is the nurse comes in, she hangs the bag, she does some buttons on the thing, and she’s like, “Okay, I’m going to watch you on the monitor, bye!” and then leaves. While if like they had to help with positions, they’re not going to be like, “Okay, bye,” they’re going to stand there and help you with the position, make sure that it feels good for you before they can leave.

Roxanne: It’s more labor intensive.

Gina: So there’s more effort on their part.

Roxanne: Repositioning is more labor intensive.

Gina: Which I could see being hard if you’re understaffed and you don’t have that many people working on Labor and Delivery.

And so what I would recommend to people that are listening, ’cause you might be like, “Oh my God, now it’s my responsibility to know all this stuff?” is one, yes, some education is really helpful so that you can, one, make sure that you’re choosing a team to support your birth, like a medical team to support your birth that you feel is going to help to really guide you during your experience. And maybe that’s not the closest provider to you. Maybe it’s one that’s a little bit further away. It doesn’t have to be the OB that you’ve been seeing since you were 16 for your annual pap smears. I don’t know when you start…

Roxanne: Which you shouldn’t, you shouldn’t be getting pap smears at 16.

Gina: I don’t know when you get pap smears.

Roxanne: 21, guys.

Gina: 21.

Roxanne: Every three to five years if they’re normal.

Gina: So it doesn’t have to be just like your standard gynecologist that you’ve been seeing your whole life, or your family medicine doctor or whoever. Like maybe it’s a provider that’s a little bit further away that you feel more comfortable with that you think, that you know, is going to explore stuff with you a little bit more.

So first thing is choosing a medical team to support you that you feel confident is going to actually support you through a variety of different experiences.

Roxanne: And look at the full picture.

Gina: Yeah.

Roxanne: Not just medical interventions.

Gina: So in addition to choosing your medical team, you can also choose non-medical support people to support your birth as well. So one, your partner. You and your partner, educating yourselves on your options and being informed on the interventions and the non-medical interventions that you have available to you. So understanding different laboring positions, different movements and stuff that you can try. Know what a peanut ball is, know how to use a birth ball, know comfort measures. All that stuff can be really beneficial to helping you be able to navigate your labor experience with more confidence as well. Like you don’t have to do it all yourself, but being informed on what options are available is going to help you to facilitate conversations so that you can receive the care that you’re wanting as well.

And so in addition to the medical team, your partner, you can also have other non-medical support persons, such as a birth doula, which are typically very familiar with labor, and they also tend to have a good relationship with you ideally, and they’re going to be with you the whole time. So like your labor nurse will come in and out, your provider will pop in once and then they’ll, you’ll probably see ’em again when your baby is crowning.

Roxanne: If you’re at a hospital.

Gina: If you’re at a hospital.

So in addition to your medical provider, your partner, other non-medical support people that you can have support your labor is going to be like a doula, or even like a friend or family member that is really well versed in labor- maybe they’ve had a bunch of kids, but depending on how many kids they have, they may not be able to.

Roxanne: They may not have time for you.

Gina: They may not have time to support your birth. So, within reason! But having this non-medical support person that is going to provide continuous labor support can be incredibly beneficial, especially if they are familiar with laboring positions and movements to address these issues during birth.

So for me as a doula, I am much more well-versed in movements than Roxanne is. But Roxanne is well more well versed in like medical interventions and things like that. And so the combination of our powers combined provides tons of amazing labor support.

And so my expertise is going to be with movement because I don’t have other things in my toolbox. My toolbox is full of a lot of movement and hip squeezes, Roxanne’s toolbox is a little bit bigger with some other things within it. And so combining efforts together is going to provide better labor support. But the big thing with a doula is they provide continuous labor support. Your labor nurse will probably be popping in and out ’cause they’ve got other things that they’re focusing on, maybe like another patient, sometimes. But typically your labor nurse is not going to be in the room with you, your entire labor- especially if their shift is over, they’re going to go home, unless your baby is about to fall out, then sometimes they stay. But typically they’re like, “Bye, my shift is over. Here’s your new friend.”

Roxanne: I have kids too!

Gina: But they’re going to be popping in and out, while a doula is going to be with you. Ideally the whole time, from when you call them, until your baby’s born and they’re with you like in the room, which is one of the big reasons why like I have been able to really identify like these little subtle cues of labor progress and what is going on, because I’m literally just watching somebody labor for hours. Roxanne’s not sitting in the room with you, watching you labor for hours, but Gina is.

Roxanne: At the birth center, I do, though.

Gina: Yeah. So different hospital settings or different birth location settings, it will be slightly different, but typically in a hospital setting, a doula is going to be with you the whole time, while other support people may be coming in and out, especially the medical support team. And so having other people there who are really familiar with labor and are familiar with the subtle cues of labor shifting, or maybe not shifting in the way that it should, can be really beneficial as well.

So be picky on who you choose to support your birth. You and your partner, educate yourself on your options and be informed on what is available to you at your birth location, and then consider having additional support people there for you. So like I had Roxanne at my labor, I had my mom, I had my husband, and I had Brittany, our birth photographer slash doula that was there, and everyone was like, would see moments where I needed a little bit more and would provide that additional support for me, and it helped me feel so much more confident during my own labor. And I had some stalls during my own birth. Roxanne has had some stalls. And so just because you have a stall doesn’t mean that there’s something inherently wrong with your labor, sometimes it’s just like a little movement shift that we need to do.

Roxanne: Sometimes your babies are eight and a half pounds.

Gina: Yeah, it’s just, you never know.

But thank you so much for listening to this podcast episode. Hopefully it gave you some tools on what to do if your labor is stalling, which again is not necessarily bad, but we may want to address it with different movement techniques to help either adjust baby’s position or to create a little bit more space within the pelvis.

Again, check out the show notes. There’s going to be tons of resources in there for different movement techniques. Check out our online childbirth education course where we break this down with video demonstrations in so much more depth with a PDF guide where you can just print out, then just have it available for you in your labor. So you can just reference it, you can laminate it, you could take notes. It’s pretty, it’s a pretty nice little guide that we’re all, we’re very proud of. And then check out our online prenatal fitness programs, ’cause we include a lot of movements within it to help support your pregnancies so that you’re comfortable during it, and also to help prepare you for birth by ensuring that you know how to do movements to create space in the different parts of your pelvis, to release tension within your pelvic floor, and to support your baby’s position.

So check our online courses so you can bundle them together to save 15% off and then you can add on another 10% off with code STORY10.

And this podcast is sponsored by Needed. Needed is a nutrition company that specializes in optimizing nourishment for the perinatal timeframe. And you can use our code MAMASTEPOD to get 20% off your order.