The MamasteFit Podcast Episode 123 – Understanding & Correcting “Power Stalls” in Labor

Gina: Welcome to the MamasteFit Podcast. In this episode, we’re going to continue our series on labor stalls, but we’re going to be talking about the power stalls. So, what kind of things are contributing towards whether or not your contractions are going to be really strong and regular, or maybe we need to look to see what other factors may be contributing towards the strength of your contractions.

Welcome to the MamasteFit Podcast. In this mini episode, we’re talking all about the third type of labor stall, power, which is related to how strong your contractions are.

Some folks will believe that there are four types of labor stalls, so we have the passenger and the passage, which we just did a full podcast episode on, on Wednesday. So if you want to hear about those two causes, how to know that you’re having that type of labor stall and also how to solve it, go listen to our last podcast episode. The other one is going to be power, which is how strong are contractions. And then the fourth potential one is psyche, so how are you feeling? But we think that power and psyche are combined together because how you feel impacts the strength of your contractions. If you believe that they’re two separate things, that’s totally fine, but for this episode, we are combining them together.

So with a power stall, typically what happens is your contractions start to space out, or they’re not really increasing in intensity, and it could be related to a number of things. For me and my own labor, so my last labor that I had in October, no, August- I always get mixed up between my last two kids’, like birth months- in August.

Roxanne: You got too many kids!

Gina: I got too many kids! So in August, when I gave birth to my fourth baby, my labor was not really progressing during the day. And the biggest reason was I had my three kids on the outside that were running around. Everyone else was finishing up other tasks that they had to do. Roxanne was at like kindergarten orientation or something, and my husband was at the range for work, and my mom was like finishing up in her garden before a baby was coming and she was going to be completely consumed with that. And so everyone was like finishing up all of their tasks, and I was like, “It’s fine. I can watch all the kids,” but my labor would not progress, because I’m chasing after these three kids.

Roxanne: You’re busy.

Gina: Once everyone else started to show up, my labor started to pick up a little bit more. And then there were points during my labor where too many people were trying to talk to me, ’cause they were all arriving at kind of the same time. So our birth photographer was talking to me, the birth assistant, the midwife, my mom, Roxanne, my children, like everyone was like, “We all need to converse with Gina.”

Roxanne: Gina was just like, “Shut the fuck up!”

Gina: But the problem was, I was like actively conversing too. So everyone assumed that I was cool with it. And then as soon as everyone left the room and it was just me and Roxanne, I was like, “Everyone just needs to shut the fuck up. Like I can’t focus.” But I did not communicate that in any way prior! Like I gave no signs that this was how I was feeling.

Roxanne: So we all left the room and let Gina labor by herself.

Gina: So I went for some walks where it was just me and my husband. I think my son came with me for one of them, and that kind of helped me come into my own zone. And then I started taking showers just by myself, ’cause Roxanne wasn’t going to follow me in the shower.

Roxanne: I did take a video.

Gina: You did take a video. But, I was finding places where it would just be me and my husband and I can just focus. And then once the sun set, things really picked up pretty quickly from there.

And so that would be an example of a power stall. It didn’t necessarily mean that anything was like wrong with my labor or that it was not going to eventually progress once I shifted the environment. But I was pretty distracted during the day, I had other things that I was focusing on, so I couldn’t really just tune in to my labor. And once I was able to do that, things really shifted pretty quickly for me. So maybe I could have had a daytime baby if I just focused better. But that would be one of the things that I would say can contribute towards a power stall, is you feel very distracted, you mentally cannot drop in to labor land ’cause there’s too many things going on, people are asking you too many questions, or there’s a big transition that’s happening. So you go from your home to your birth location, if you’re giving birth at home, your team arrives, and so there’s a little bit of commotion with that, that can be a little distracting. And sometimes that can cause your labor to pause for a little bit. If you have a nurse that walks in and has this really booming voice and doesn’t read the room very well, and she’s like, “How are you guys doing?” and it’s like, “Can we bring it down a few notches?” So sometimes the people in your environment can affect the vibe of your labor, which could sometimes cause it to stall, or pause for a little bit, until you feel like you’re safe and ready to go into labor.

So that would be one example of a labor stall. What’s like another thing that can contribute towards a power stall.

Roxanne: Another thing that can definitely- like other than the psyche, like your mental state and your temperament during like the stages of labor- that can contribute to a power stall, are like how are you doing like, resting-wise? Are you full of energy, or did you just stay up for 24 hours and you are in desperate need of a little nap? Your contractions in normal physiologic labor will start to slow down and decrease an intensity so that you can take a nap, so that your muscles ’cause your uterus is a muscle and like your other muscles need to rest and recover a little bit. So I find that if you had a really long labor, or like maybe your labor’s only been going on for 12 hours, but you were like awake for the previous 12 hours at work or doing stuff, then sometimes your labor will not progress until you get like some sort of nap in there.

Usually you can get a short little nap and then you’re like ready to go, but if it, the labor just continues and continues and you’re not able to ever rest, eventually at some point, like we need to start thinking about how can we get you some sort of rest, whether getting in the shower, getting in the tub, or potentially thinking about other pain relief options.

Gina: One of the things that some of my clients will use if like rest is the reason why things are starting to space out, like they’re fatigued, is when the tub will be like a good place to go to rest for a little bit, sometimes it can help things slow down a little. Another thing would be like Benadryl and Tylenol, like combo sometimes helps. I’ve had some of them get Ambien from their providers to like, just go to sleep for a little bit. And then, epidural would be, like, the not last resort, but one of the options that could help if you’ve been laboring for a really long period of time. And sometimes I’ll find that once they get an epidural and they get like a good sleep. All of a sudden they’re 10 centimeters and their body’s ready to go, and then now they’re rested to start pushing, ’cause pushing is a really physically intensive thing.

Roxanne: Yes!

Gina: And so if you’ve been awake for several days, sometimes getting some rest before you start pushing can also be beneficial. So remembering that epidurals are tools that are available to us should we need them during our labors.

Another thing that I’ll commonly see that can contribute towards a power related stall is your hunger. So how nourished are you? Are you starving? Are you super hungry? And then also your hydration status.

So with hunger, if you have not eaten in a prolonged period of time, your uterus is going to have a hard time working. It’s a muscle, it needs fuel to sustain itself. And so if you’re an early labor, I really recommend eating like a meal during that timeframe, especially one that’s like high in fat and protein so it can sustain you for a period of time. Once you’ve hit active labor, it’s typically a little bit harder to eat ’cause you’re just… it’s just tougher during active labor. So like bite-sized snacks and things can be helpful, or, shifting more to focusing on hydration during active labor.

Now if things are stalling where you’re having, like, your contractions are really spacing out, you’re coming out of labor land, this is where like eating something a little bit more substantial could be beneficial at that point as well, especially if you’re like, wow, I’m like super hungry.

With hydration, drinking water is obviously incredibly beneficial, but we can also add in like electrolytes as well to help improve hydration. LMNT is one of our favorite electrolyte salts- I personally like the stronger flavor, it’s on the salty side. There are other options out there, but we’re big fans of LMNT. We’ll link our affiliate link down in the show notes, it’s just DrinkLMNT.com/Mamaste. With it, you can grab an insider bundle. They have four packs, or four boxes within it, so you essentially get three boxes, or four boxes for the price of three. And they have a really good return policy. So if you get it and then you decide that you don’t like it, you can always return it or get your money back and just move on with your life. But we’re huge fans of LMNT. My favorite is watermelon. What’s your favorite?

Roxanne: My favorite is the grapefruit or the orange. I like all the citrus flavors. The mango chili is my third favorite, and that’s also really good if you make it into a margarita or a fake…

Gina: Like a Mockerita.

Roxanne: Mockerita.

Gina: Yeah. You’re probably not going to be having Margarita during labor.

Roxanne: Not In labor, but like you like blend it up on some ice, like it’s pretty dang good.

Gina: So when we’re thinking about supporting our labor progress, we want to make sure that we are hydrating ourselves with a little bit more than just plain water because when we are more hydrated, our uterus is more coordinated and it works better. So sometimes during pregnancy, if you’re having a lot of Braxton Hicks contractions, or even like prodromal labor where it doesn’t progress, it could be due to your hydration status, too. And so you might just not have enough fluids in your body and your uterus is like, “I don’t know what to do,” and just starts cramping, so when we are better hydrated, I find that our contractions tend to be more effective during labor as well. If you are having a hard time drinking water or ingesting fluids during your labor, this is where IV fluids can be really helpful and I sometimes will find that can be like something that really helps somebody whose contraction pattern is a little irregular, or they’re spacing out a little bit more, getting some IV fluids can really help boost their hydration.

Roxanne: So just to round it up, your uterus is a muscle, and it needs like all of these things in order to work, just like any other muscle within our body. Like you would not run a marathon without any sort of like sleep beforehand, any sort of hydration during the marathon, as well as some sort of snack throughout the marathon, to give your body like fuel and hydration. The uterus is the same thing during labor. We will ideally compare labor to a marathon, it is not a sprint. For some of us it is a sprint, but for the majority of us, it is some sort of long distance race where we need to be able to fuel our muscle to be able to work efficiently, hydrate it, as well as give it enough time to have recovered, to be able to work more efficiently.

So if we can think about that going into labor, this is why I always emphasize, if you are in early labor, go to sleep. Eat a meal, drink some fluids, go to bed. If you wake up and it’s like you’re the one person, like Gina, that wakes up in the morning, rested and then labor begins, okay, no, you don’t need to continue to sleep at that point, but eat and hydrate. So think those are like the big three things, like these are the things to emphasize to avoid, potentially a power stall later in labor.

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The last thing that can contribute towards a power related stall is your health status. So if you are starting to get sick during your labor, this is going to impact how well your uterus can contract and help to move your baby down. And so when we start to have a health related complication that is impacting our labor progress, this is where more of a conversation of what your threshold is that you want to stay within. For some folks, once their health starts to decline during labor, it’s typically not like an emergency right away, once you get a fever, it’s not like panic and emergency, but it could eventually lead to a more emergent situation in your birth. And so it becomes this threshold, and it’s going to be individual for you as a family to figure out, “Okay, my health is declining. How close am I to having my baby? If I am like 10 centimeters, we’ll just push the baby out. If I am 3 centimeters, maybe it’s a different conversation, or maybe we see how quickly things start to progress.”

And so there’s this threshold, there’s no like set point or trigger point where it’s, once you hit this, we need to change our path from trying to have a vaginal birth to going towards a cesarean birth. But there should be a conversation that happens if you start to have a fever, your labor is starting to stall, baby is starting to have more of an elevated heart rate, or there’s some sort of signs that maybe baby is not tolerating this as well, and figure out, okay, do we want to continue to push for a vaginal birth or do we want to pivot and move towards a cesarean when it’s not an emergency yet? And again, this will vary from person to person. I’ve had some clients where their health was starting to be a complication for them, and for some of them they were like, “All right, I don’t want it to be an emergency. I’ve had an emergency C-section before, and that was not fun to be in. So I want to make a choice now to go ahead and shift to its C-section when it’s still it’s… we could be calm, we can be calm about it.” I’ve had other clients who are like, “I want to talk to anesthesia to understand how quickly they could give me, like any sort of pain relief, ’cause I’m unmedicated right now, should it shift to an emergency? Or, do I want to get an epidural now in case it shifts and then go from there?” And so there’s different decision points that you can make, but having the conversation with your provider in the moment is going to be really helpful at that time.

Roxanne: Yes. And there are different types of infections that can arise during pregnancy or during labor. The most common one is what we would call chorioamnioitis, which is an infection within the uterine cavity, so like where baby is, it’s like the amniotic fluid, amniotic sac, uterus, just depending on how severe it is, what is affected. But when your uterus, because it’s a muscle, when it’s infected, it’s not going to be able to work as efficiently, just like if you had the flu, you’re not going to be able to do the same level of exercise as efficiently because your body is like, “Oh, I don’t feel well. My muscles are all tired.” The uterus is also getting tired. And also, if you are unmedicated, even sometimes with an epidural, those contractions are more painful because your muscle is not doing well- it’s tired and it’s sick, and so usually those contractions feel way more painful and it’s like almost a constant pain. And if you even touch the belly sometimes it’s very painful, because again, it’s just sore and tired. And that’s probably the most common type of infection that arises.

Something that we can do to hopefully prevent these infections though, is limit vaginal exams. So if you are ruptured, your amniotic sac is ruptured, we want to try to prevent infections so we don’t lead to this type of stall. So by limiting vaginal exams, we’re not checking you very often, this is going to hopefully decrease that risk. But sometimes you can also get an infection when your amniotic sac is still intact. This can either be preterm or post-term, I guess not really post-term, but like after 37 weeks, and that could be GBS related, sometimes you can get the infection and your water still be intact. And when the water does break, it has a very specific not-great odor, and that to us tells us, “Oh yeah, this is probably an infection.”

We can give you antibiotics. We can do things to help treat the infection before you need to immediately, it’s not like an immediate rush to a C-section. We can give antibiotics, we can give you things for your uterus to be able to have stronger contractions, but again, it becomes a threshold for what you are comfortable with and what like the full picture looks like. What does your health status look like? What does baby’s health status look like? If we continue, what is the likelihood that you would need more help afterwards? Or what is the likelihood that baby might need to go to the NICU? So determining what is like the ultimate goal for you of, “Hey, after my baby’s born, I would like to be with my baby, like immediately to try to do skin to skin,” maybe, if this looks like potentially if we continue baby might need to go to the NICU based off what they’re telling us on the monitor and with your labor, then maybe you would make that decision earlier to go towards a C-section. Not just like how are you doing, but like also baby, that’s like, a lot of people would choose, “Hey, if you think I need to, like, if baby’s showing signs of infection maybe like having the C-section now so that they don’t have to go to the NICU and we have to be separated.”

Gina: It’ll be really individualized.

Roxanne: It’s another like factor into the decision. But it’s very individual based. Some people choose against one thing and another family will choose for it. And so that’s why it becomes really important to have a conversation if we think health is becoming a thing.

Also, like it’s not always just an infection. It could also be related to things that arise during your pregnancy, like blood pressure issues. And then like sometimes if you’re just, if you have a complication like gestational diabetes that is starting to affect baby, like all of these other things, it’s not always just an infection, it’s like a full picture. These are all conversations that your provider’s having with you about how is that uterus handling this and how is baby handling this? And then making that choice based off of yourself.

Gina: It’ll be based on that specific scenario as well. And having that conversation in the moment I find can be really beneficial.

So to sum up power stalls, the way to solve them is to address whatever the underlying issue is. So if your environment is set up to where it’s really loud, it’s really distracting, like you cannot tune in…

Roxanne: You feel unsafe.

Gina: …to your own little labor land.

Roxanne: You feel unsupported.

Gina: Like you don’t feel safe or supported. Maybe there’s someone that’s causing a lot of conflict for you, like your provider is scaring you, or this nurse is not great. Maybe like your mother-in-law showed up and, you’re like…

Roxanne: Or your father-in-law.

Gina: Your father-in-law. That happened once where I was like, “Who is this random man that just busted in the room?” I’m like, “Why would the nurse just let him in?”

Roxanne: And I know him, so I just imagine this happening every single time!

Gina: It’s like, oh my gosh.

So if your environment is making you not feel safe or supported or you’re really distracted, changing the environment can be really helpful. So, removing the people that are not being supportive for you. Can we dim the lights? Can we speak in quiet voices? Play some soft music to set the vibe. So think like spa-like vibe is what we’re looking for. And that can really help your labor progress because this is going to help with your oxytocin release, which is a huge part of your labor feedback loop. And we’ll link our video down below that has more on contractions and the hormones that contribute towards those contractions.

If the issue is related to your nourishment and your fatigue levels, resting is probably going to boost all that- potentially looking at getting an epidural If it’s been a long time and you’re having a hard time sleeping. Eating food.

Roxanne: I know, so simple.

Gina: Some sort of sustainment. Drinking fluids, especially something that has electrolytes in it, like LMNT. There’s so many great options out there, so you could definitely find what works best for you, LMNT is just our personal favorite during all phases of life, to include labor.

And then monitoring your health status, like what’s going on with your health that is maybe impacting or do you have a fever? Are you developing an infection? Is your blood pressure starting to really skyrocket? Is baby showing signs that they’re not tolerating this anymore? And at that point, potentially looking at, how can we treat whatever’s going on with my health and potentially pivoting to a different path?

Another tool that can be helpful if your contractions are spacing out, where they’re not strong enough, is looking at Pitocin. And so this is where Pitocin could potentially be a helpful tool, but if we can address the other underlying reasons for a power related stall, typically we see labor progress. And so it’s not always jump to medicine right away. It’s a tool that’s available. It’s not bad to utilize by any means. It’s a tool. But if we can look at these other reasons that may be contributing towards the stall, we may find that things progress and they pick up from there.

So when we are looking at is there an issue with the labor, and I think some of these are not necessarily like, issues, really they’re just like a normal progression during labor, when you’re feeling more tired, your labor will slow down to let you rest. If you’re feeling hungry, your labor will slow down so that you can eat, and then once you eat, it picks back up. But not all of us know that we can sleep, or that if it slows down that we should sleep, we might think that’s a problem that our labor is slowing down, so let’s give you Pitocin.

Roxanne: Yeah.

Gina: As opposed to being like, “Why don’t you take a nap?” If your labor is slowing down because you haven’t eaten, ’cause I’ve seen this in like home birth, where like someone’s getting hungry and then they’ll eat food and then their water breaks and their baby falls out, and it’s, “Okay!”

Roxanne: “You just needed some food!”

Gina: “You just needed some eggs!”

Roxanne: Shocking.

Gina: That’s all you needed. So these are normal pauses that your labor will take so that you can get your nourishment and you can get your rest. But it may appear that something is wrong because labor is slowing down, it’s not progressing anymore.

And so understanding the root cause of whatever is contributing towards your stall, whether it be your baby’s position, space within your pelvis, or the strength of your contractions can usually help to resolve whatever the “issue”, quote unquote, is. And then if that stuff doesn’t work, then maybe we look at Pitocin, maybe we look at more invasive things to help support our labor experience.

Roxanne: Yes, and I think that’s so important to emphasize, that with any of these stalls, the passenger, passage, even the power stall, where, potentially, Pitocin is more likely of an option for a power stall, it’s still, “Hey, when’s the last time that you’ve ate or drank something? Oh, has it been a while? Let’s try that first.” “Oh, like, how are you feeling emotionally? Let’s check in with you. Are you feeling nervous, anxious?” Just asking these questions.

And I think like, at the home birth that I was at, the mom was starting to struggle mentally. And instead of like the midwife, I think she had asked for a cervical check just to be like, “Hey, like where, are we at?” The midwife went over and was just like, “Hey, tell me what’s going on. What are you feeling inside?” And she was just like, “I feel like it’s taking a really long time.” And sometimes that’s all you really needed, to express how you were feeling and why you’re feeling stressed, and then like literally like I think that was like 20, 30 minutes later, her baby was born, but she needed to get all of these out.

Gina: Vocalize that.

Roxanne: Yeah. Yeah, and I think, similar with my first birth, like I was at home, like granted it could have just been normal, but like I was like, “She’s not going to fit, like I’m really nervous, she’s too big and she’s not going to fit.” And you just like acknowledged my fear and were like, “Valid, but also she’s going to fit. You are not going to grow a baby that’s too big for your body,” and like all of these like encouraging words, sometimes that psyche can really take over. And had that happened potentially at another birth location, like they might’ve been like, “Hey, like you’re starting to struggle and maybe we should just get you an epidural and then start Pitocin.” And like those type of things is when that cascade of interventions can start versus, “Hey, let’s just take the time to check in. When did you eat? When did you pee last, also?

Gina: Yeah, that can be a big one.

Roxanne: When did you pee last? When did you drink last? Like, you’ve been up for 36 hours, like maybe we can take a nap real quick. Check in on all of those other things before being like, “Hey, Pitocin. Epidural, Pitocin, ’cause you are, you’re no longer coping well.” When you could just be like, “Fuck this shit.”

Gina: So when addressing labor solves, there is some complexity to it, and it does take effort on your support team. So it’s really easy to just give someone Pitocin and walk away, go watch the monitor. It’s much harder to dive in and figure out what are the possible underlying issues. So if you want to learn more on a physiologic birth, what is normal, and then what to do when things are not potentially normal, how to resolve some of those issues check out our online childbirth education course where we fill it with tons of information to guide you through this. And you can also join our new community where you can ask questions, we do monthly webinars and we also include tons of resources within the community in a way that is a little bit different than a self-paced course, so this is going to be a learn with us as your pregnancy progresses. So check out our new community as well.

Hopefully you’ve learned a ton this week, all about labor stalls. Tuesday’s YouTube video was some movements that you can do to help resolve late labor stalls with a single knee hip shift and the cook’s counter pressure. Wednesday was all about passage and passenger stalls, so what to do if baby’s in a funky position, or we’re trying to create a little bit more space in the pelvis. And then today’s was obviously the power stall, so when contractions are not strong enough, quote unquote.

Roxanne: Drink some LMNT.

Gina: And so check out those episodes and we are excited to continue to learn with you with all of our free resources. And if you want to pay us money, check out our paid courses as well.

And this podcast is sponsored by Needed. Needed is nutrition company that specializes in optimizing nourishment for the perinatal timeframe that Roxanne and I personally use and trust. And you can check them out at thisisneeded.com and use our code MAMASTEPOD to get 20% off your order.