|Posted by firstname.lastname@example.org on August 17, 2015 at 1:00 AM|
Not every labor is a marathon; some take only a few hours. But are these so-called precipitous births really abnormal, or are they more common than we think?
Soon after I began assembling a bed frame, which I thought would be a good labor project, my contractions started. I was excited, and decided to time them. The clock showed 1:22 p.m. After having two waves about five minutes apart, I shared the news with Gus, my husband, so we coulad give our midwives an early heads-up. Our daughter, Zoe, had been fast for a first-time birth, and we knew that second births are often faster.
We paged Christine, our primary midwife, at 1:37 p.m., and told her that the waves had just started, but not to come yet. We agreed to touch base in 30 minutes.
I went back to my labor project. But the waves started coming faster, and I couldn’t focus anymore. Meanwhile, Gus was making arrangements for our birth and getting the place ready as quickly as possible. He called my mom, and asked if she could come and look after Zoe.
While Gus made us lunch, I was pacing. The waves were coming on continuously, and growing stronger. I could not stay still. I paced upstairs; I paced downstairs. I remember bending over the cabinet by the door as another progressing wave overtook me.
Gus stopped me on the stairs, thrusting half a piece of toast into my hand. Thinking it was a good idea, I started to eat. Then, because I was progressing so quickly, the food turned to cardboard in my mouth and I had to spit it out.
Over the next 40 minutes Gus continued calmly running around making preparations, while I floated around the house. The waves were coming faster now, with more and more urgency, and in between them I had to keep moving. Gus fed Zoe lunch, and put her in front of the TV to watch a movie. He filled the bathtub partially full of water (there was not enough time to fill our birth pool), and periodically checked in on me.
At approximately 2:15 p.m., I felt what I thought was an urgency to clear my bowels, which I had done before Zoe’s birth. But when I sat on the toilet and pushed, I immediately realized it was a very bad idea. Powerful waves of pain overtook me, coming like a Mack truck— searing, piercing pain that alarmed and shook me. I got off the toilet, but the waves came still more angrily, and I had to bend over and brace myself.
A few minutes later, Gus came in to check on me, and I told him to page Christine right away. The waves were progressing quickly and I knew we needed her there. Waves like vice grips shot through my body, and I started getting really scared. Christine was 30 minutes away. I started to freak out. No one was there yet, and the ferociousness and urgency of each wave was scaring me.
On all fours, I leaned over the bed, bracing myself for the next piercing wave, softly moaning with it as it passed through me. That was how Gus found me. He put his hand on the small of my back and said, “Jac, are you OK?” That’s when I realized that I was shivering and shuddering between the waves. I couldn’t talk. I was bent over, instinctual, primal.
Gus intuitively reached down under my bottom, and said, “My God, Jac, the baby is coming!” His calm state was replaced with a halted, urgent state of emergency. ”Jac, just hold on till the midwives come!”
When he told me that the baby was there, it completely changed my resolve. I woke up out of my fear, feeling tremendous relief that it was OK, and I could push now. With the next wave I didn’t hold back. I let it overtake me and I pushed. From behind me, Gus exclaimed, “My God, it’s his head!!!”
I was empowered. I knew intuitively that it was OK. I could let the baby come out. And with the next wave I again pushed…and all in one swoosh, out came Max into Gus’ outstretched hands.
At 2:37 p.m., about 10 minutes later, Gus paged our midwife, Christine, sharing that we had had the baby, and that mom and baby were doing well.
Our Birth Stories
This was our second birth. Prior to Max, our daughter Zoe had been born at home in a water birth. And following Max’s birth, our second son, Caleo, and our second daughter, Matea, were also born at home, similar to Max’s birth, each in under two hours. We had been blessed with four beautiful “fast” birth experiences at home.
I’ve spent a lot of time contemplating what it was that gave me the faith to trust my body. What helped us carve our path, so starkly different from an allopathic hospital birth.
I believe the trust and faith grew from our chiropractic paradigm. My husband and I both have faith in our bodies’ innate intelligence, and the universal intelligence that placed it there. We see birth as a natural, inborn process, and we wanted to have the healthiest, gentlest and safest births for our children, so that they could be born at their fullest potential.
After Max’s birth, I felt the need to explore fast births. I needed to discover if they are really as rare as is commonly thought, and to hear from other women who had had similar fast birth experiences, to find out if there is universality in faith and trust that helps facilitate them.
Precipitous Labor and Birth
Max was born in approximately 70 minutes. That’s from my first contraction until he barreled out into the world. Our second son Caleo’s birth took 1 hour and 25 minutes, and our second daughter Matea’s birth was approximately 1 hour and 40 minutes.
Fast labors and births such as these are called “precipitous.” Precipitous is defined as “very steep, perpendicular, or overhanging in rise and fall; having a very steep ascent.” Some of its synonyms are hasty, rash, hurried, helter-skelter, drive-by and rushed. There is often an element of surprise in these births, as many of us are unprepared for how fast the natural birth process can be.
The medical definition of a precipitous birth is a labor in which the labor and birth, from first contraction to the birth of the baby, occurs in three hours or less.
Upon reading many women’s stories of precipitous labor and births, I found that most of these birth stories were inspirational stories of natural birth, with no medical intervention, that just happened quickly. Beautiful births were described: gentle, spiritual and without fear, where the mind and body were connected.
This is not how precipitous labors and births are usually portrayed in the media. Most often they are shown as emergencies, or in medical terms as BBA, or “birth before arrival,” meaning birth before arrival in hospital. For example, there’s the cliché of the mom giving birth in the car because she can’t get to the hospital on time. As a result of the media in the Western world, precipitous labors and births are often seen as an anomaly, unusual and rare.
The medical texts support that precipitous labors and births are an anomaly. Williams Obstetrics, a leading obstetrics text in the U.S. and Canada, categorizes precipitous births as abnormal labor, or “dystocia.” The abnormal mechanism is said to be uterine dysfunction, where the uterus and abdomen contract with abnormal strength, or else there is abnormally low resistance of the soft parts of the birth canal.
This is theory, as no published studies have tested for abnormal uterine contractions or low resistance in the birth canal during precipitous labor and births. This theory also considers the cause of precipitous birth to be a physical aberration, with no consideration of the birthing mother or child’s conscious part in the birth, nor for the innate process led by universal intelligence.
Instead of accepting that our births were “abnormal,” I wondered: By what means are they defining normal? Are they defining it in a Western cultural context, or cross-culturally? And what population of women are they considering—women who have not previously given birth (nulliparas) or women who have already given birth one or more times (multiparas)?
Frequency of Precipitous Labors
One way of defining abnormality is statistical deviation. So I looked into statistics on the frequency that precipitous births occur.
There is very little published information on precipitous labor and its frequency. Most resources use figures from the U.S. National Vital Statistics Report published in 2009, which says, “while exact statistics as to the percentage of women who experience precipitous labor is not known, it is estimated at approximately 2 percent of all births.” In this report, 89,047 births out of 4.3 million live births (2 percent) were reported as complicated by precipitous labor in 2006.
The data from the previous U.S. National Vital Statistics Report, published in 2000, reported 79,933 births out of 3.9 million live births as complicated by precipitous labor in 1998, a similar finding of 2 percent.
This percentage seemed very low, so I researched how the statistics were recorded. I learned that the statistics are recorded at a state level. In the United States, state law requires birth certificates to be completed for all births. For each birth, either the birth attendant, the hospital administrator or a designated representative of the facility where the birth occurs is required to record and register the birth record.
This indirect recording of statistics may lead to underreporting. As hospital administrators, a fast birth might not be ranked as medical details that need to be recorded on a separate section of the birth record. They might not consider it a “medical labor complication,” as it is designated in the National Vital Statistics Report. And so many precipitous births may go unreported.
Another study was done to determine the extent to which the accuracy of birth certificate data varies by risk factors and outcomes. The results showed that underreporting of birth certificate data elements varies by maternal characteristics, particularly English language proficiency. The study demonstrated that it is important to consider subgroups (such as ethnicity and English language proficiency) in data quality when birth certificate data is used.
This data is also limited to the U.S. The “approximate” estimate of 2 percent does not take into account other countries, where different cultural approaches, philosophies and lower rates of medical intervention in labor and birth would likely give different statistics.
I did find an older study, conducted by Conger and Randall in 1957, that examined labor and births over a six-year period at State University of Iowa Hospitals. It found an incidence of 10.2 percent precipitous labors.
Studies also show that the chances of precipitous labor increase for women who had given birth previously one or more times (multiparas). In one study, 99 births were identified from 1990 Bronx Municipal Hospital Center’s birth records as short labor, equal to or less than 3 hours in length. Of the 99 births, they found that 93 percent occurred in multiparas.
Conger and Randall’s 1957 study also found that women who had experienced prior precipitous labor were also more likely to have a repeated fast labor. They found that 40 percent of the 731 women with precipitous labors had a history of a past labor of three hours or less.
If there is an increased likelihood for precipitous labor in multiparas and women who have experienced prior fast labors, then these statistics need to also be considered when estimating the rate of precipitous births.
It is evident that further studies need to be conducted, cross-culturally, with better means of recording, and they need to include women who have given birth previously, in order to determine the frequency of fast births of less than 3 hours in duration. The results should show a much higher frequency than the commonly published estimate of 2 percent.
Facilitating a Precipitous Labor
Most published literature lists the determinants for a precipitous labor as physical—most commonly, the explanation given in Williams Obstetrics, listing the causes as an extremely efficient uterus that contracts with abnormal strength, or extremely unresisting soft tissues in the birth canal. Other possible physical and genetic determinants are discussed anecdotally, and include the following: a larger than average pelvic outlet; a well lined-up pelvis, pubic bone and birth canal; a smaller than average size baby; a baby who is well-positioned for descent; or a grandmother, mother or sister who also had precipitous labors.
Chiropractic helps with some of these physical determinants, such as helping to line up the pelvis and spine to help maximize the shape and size of the pelvic outlet for the baby’s descent. Chiropractic can also help reduce in-utero constraint to the baby, through the Webster technique, helping facilitate a healthier position for the baby for descent.
However, although these physical determinants may help in a precipitous labor and birth, they are only one component in the birth process. A birthing mom requires a certain mental, emotional, instinctual and spiritual state for birth, especially a fast birth.
Precipitous births can elicit tremendous fear in birthing moms, with the fast climb in intensity of contractions and the rapidly diminishing space between them. If a birthing mother succumbs to her fears, the birth process can be slowed or halted.
When our firstborn, Zoe, was born, there was a strong mental and emotional component. I learned to “let go” and surrender. My biggest fear during the waves and rushes of labor contractions was the fear of the unknown. If this current wave was that painful, I thought, what would the next be like, and how could I handle it as they increased in intensity and duration, and how long would I be able to carry on? My mental state was driving my emotional state, and ultimately driving my physical state. As I detached from the emotional fears, and mentally let go, the natural process was allowed to unfold. By letting go, I was surrendering, and giving up control, allowing the innate birth process to open up my body.
Max’s birth was a racingly instinctual birth. There was very little mental component; there wasn’t time to think about surrendering. I learned to “give way” to birth. It was like a fast-moving truck was plowing through me, and I had to give way and let it happen. It was raw and all-consuming, with instinct driving the involuntary process of birth. It was more consciously unconscious, driven by the hindbrain.
Caleo’s birth was a more spiritual experience. I got to a place where I was consciously connected with a higher power. Throughout the birth my mind was clear. I had no hesitation or fear. There was just a clear communication with God to move into each wave, and let each wave do what it needed to do. When I fully opened up to the intensity there was no pain.
In Matea’s birth, there were all components— mental, emotional, instinctual, spiritual and physical. I was completely focused within, present with each thought, moving instinctively as my body told me to, standing and moving my hips in wide circles, uninhibited, connected with our higher power and the innate wisdom of my body and Matea’s moving down the birth canal. Again, there was no pain.
When I explored the precipitous birth stories of other women, they shared similar experiences. The commonality seemed to be the application of “letting go,” or surrendering and trusting in the natural, inborn wisdom of the body during birth.
Through this process of exploration, uncovering what remarkably little published literature there is on precipitous labor and births, I learned that what has been written needs to be redefined. It is not abnormal for a birth to progress quickly. The frequency at which they occur may range from 2 to 10 percent of births, but further studies are needed, especially studies that examine how often they occur in multiparous women, in which the percentage will likely be much higher. Also, in past studies, only physical determinants for precipitous labor have been proposed. Instead, the combined physical, mental, emotional, instinctual and spiritual state of birthing mothers needs to be studied.
In redefining precipitous labor and births, we may open up the possibility that these labors and births are natural, normal and healthy…and that they may not be rare, but may occur a lot more frequently than we realize. And in studying what determines a fast labor and birth, we may be able to find out if the faith and trust that women have in their body’s inborn wisdom in birth is what facilitates them.
Written by Jacqueline Tsiapalis, D.C., FICPA
01 September 2012
This article appeared in Pathways to Family Wellness magazine, Issue #35.