What?! You Were in Labor for Three Days…?!

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You have likely heard stories, or have a friend or family member, who reports their labor lasted not just twenty-four or forty-eight hours, but literally DAYS!  Why is it that some people have multi-day labors, is it labor at all, and what can be done to address it? 

There is so much mythology around these drawn out labors and yet so many women (and their partners) who find themselves in one have no idea what it is, and how to deal with its challenges.  Let’s talk frankly about prodromal labor…

Prodromal labor describes a labor pattern in which contractions occur, but do not get stronger, longer, and closer together--as contractions do in the typical arc of childbirth, and as they need to in order to dilate a woman’s cervix.  

In a prodromal labor pattern contractions are persistent but inconsistent. A woman might have contractions every seven minutes for two hours, every four minutes for an hour, and then every ten minutes for the next five hours.

Some women’s contractions will continue in these irregular ebbs, while other women might find that contractions fully stop for a period of time, only to pick up in full force again within hours.  Often contractions will be more frequent or intense at a specific time of day--generally evening/night.

Unfortunately this kind of pattern is dubbed by some “false labor,” which creates a stigma and invalidates the very real experience of the laboring woman and her partner.  While linear progress isn’t being made a woman’s body is still doing a ton of work towards birth.  

The primary issue in prodromal labor is fatigue.  While their timing is inconsistent contractions can be incredibly intense and prevent a woman and her partner from sleeping and getting rest.  This then becomes cyclical because it is very often rest that is needed for the body to “turn the corner” and establish a more regular and productive labor pattern.  Besides the physical exhaustion of prodromal labor, it can be extremely mentally and emotionally exhausting as well.  Women and their partners become anxious that things are not moving along as they should, that they will not have the strength and stamina for the later stages of child birth, and that they will require unwanted interventions or need to abandon their birth plan.  While these are understandable reactions and fears it is important to know that prodromal labor does not doom your labor experience.  I have clients that have had unbelievably challenging prodromal labors but have also had breathtakingly beautiful births, and feel truly satisfied!

Here are our top three tips to help manage and move through prodromal labor.

  • Hydrate and Nourish. While it is crucial all women in early labor stay well hydrated it is even more imperative for women in prodromal labor patterns to be.  The baby’s heart rate is sensitive to dehydration and in order to avoid any fetal distress in this extended phase women want to make sure they are consuming as much water as they can, and preferably something that is electrolyte-rich such as coconut water or Gatorade.  Keeping her electrolytes stable is so important for her and her baby’s health.  If she feels like eating full meals she absolutely should, and if she doesn’t feel up to it she should take advantages of times when she can to have small, protein-rich snacks, like yogurt or nuts.  
  •  Natural Rest: At home a woman and her partner want to find the most comfortable positions, and create conditions conducive to rest.  This may include a warm bath to help her relax and space out contractions and position changes--such as side lying in bed with strategically placed pillows—to help her relieve tension in her back.  She and her partner should try not to become fixated on timing contractions.  While excitement and anxiety are normal it is important to stay loose in the body and conserve energy.  Try to think of it as the laziest Sunday of your life.  The hope is that you can lull the body into a deeper, restorative rest.
  • “Therapeutic Rest”: Getting that kind of restorative rest in the home environment may not be possible, depending on the intensity and duration of contractions.  A woman will likely be in touch with her care provider when she recognizes she is in labor, and he or she may offer therapeutic rest if the prodromal pattern is not resolving and the care provider thinks exhaustion is impeding labor’s natural progress.  Therapeutic rest is a pharmaceutical option, usually a narcotic, which a woman is given in hospital.  It helps her to sleep and knocks out contractions, usually lasting about four hours.  In most cases after receiving therapeutic rest a woman wakes refreshed and in active labor.  A doctor may also give a woman a lower class of drug such as Benadryl that she can take at home.  It is very common in prodromal labors that couples go into the hospital a few times before they are admitted, as they try to interpret their labor signs.

As a doula, in supporting clients in prodromal labor, the above three tools are essential in keeping couples calm and positively engaged. There can be an enormous amount of frustration and discouragement in prodromal labor patterns.  The emotional and psychological resilience is just as important as the physical fortitude.  Attending and attuning not only to the laboring woman but her partner is also a priority, as it is often deeply upsetting for partners to witness their loved one in unrelenting labor, and for them to remember to eat or take care of themselves.  I might do phone support for two or three days before a client has shifted into a more productive pattern and is ready for face to face support, or I might join the couple for a stretch so the partner can rest on his or her own, knowing someone is taking care of mum.  

There is no way to predict beforehand if a woman will be struck with prodromal labor, and because of the uterus’ ability and memory, it only occurs with first time mums.  While couples planning on a low-intervention or unmedicated birth may be concerned that prodromal labor means drugs or interventions, I assure you I have had prodromal clients who had entirely natural, utterly stunning natural deliveries.

Prodromal labor is not at all myth; it is a real clinical phenomenon.  While the prodromal labor arc is more arduous than a “typical” one, we want and work to support women and their partners to confidently navigate it, and chart the course to their own magnificent birth.

Simone Rowen is a labor & postpartum doula living in the Andersonville neighborhood of Chicago.

Caitlin Sobotka