Please don’t ignore women who aren’t in ‘established’ labour

Please don’t ignore women who aren’t in ‘established’ labour

I hear so many stories from women about being ignored in early labour, not being given pain relief and not taken seriously. I get it from women I meet when they find out I’m a midwife, from women who contact me online, and also from women coming back for their next baby when I book them in my role as a midwife. This is a plea for my fellow midwives.

Please don’t ignore women’s pain.

Please don’t dismiss their pains as if they don’t mean anything unless they’re ‘in labour’ officially.

Whether they’re 1cm, closed cervix or anything else up to the magical 4cm of established labour, their pain is still real, part of their labour story. It’s what they’ll remember, how they were treated for all the hours.

What I’m talking about today, is the patchy care that gets given to these women who are in hospital with latent or early labour. Quite often they’re primips (first time mums), often induced. They’ve been induced for a valid reason, perhaps they have a medical or pregnancy induced condition that means the baby is better off being born rather than going to natural term, perhaps they’re overdue more than 13 days. If they get pains from the induction medication, these are often dismissed as ‘tightenings,’ or ‘prostin pains.’

Please don’t dismiss these out of hand. Yes, they may die down, they may be irregular, but these women have waited 9 months to get to this long awaited day, they are excited and fearful and every twinge means something. The pain is real. Yes, it’s going to get worse, yes it’s the tip of the iceberg, but acknowledge it as the start of something. Get excited with them. Read the birth plan and discuss it with them. Offer some sort of pain relief, some coping strategies more than just – go have a bath and take some paracetamol. Reassure them that this is normal, it’s good that it’s happening. We’re all busy but there is time for these things to be done, even if it’s the promise of coming back and being with them for 10 minutes.

If they’re ‘only’ 1-2cm – celebrate that they’ve come this far. Offer your support and encouragement. There’s such a huge variation of labour experiences – with common themes. Some women have regular painful contractions from the start, but it’s only when they go over the 4cm threshold that they get taken seriously, yet these contractions past the threshold feel no different to the woman than those early pains. Others may have had irregular contractions over several days, sometimes stopping altogether before labour finally establishes and then the contractions shift, feeling different, more intense and are more regular. Both are normal as are shades of everything in between. I’ve seen first time mums progress rapidly many a time, use your instincts and if in doubt, check. All too often I’ve heard of women being induced who are ignored, then they get to fully dilated or near enough, then there’s suddenly a big panic which is easily avoided if we listen to women. They know their bodies.

If you’re reading as a pregnant mum

What is established or active labour?

Established labour is defined as:

The onset of regular, painful contractions that dilate the cervix

In many UK NHS trusts, when a woman gets to 4cm and is having regular contractions, she is suddenly pronounced to be in established labour, and the clock starts ticking. She must progress to a certain timeline and not deviate. Most commonly this is 1cm an hour, with some give or take a half centimetre. Once you reach full dilatation this stage should be no more than 2 hours maximum. I wish it wasn’t so linear. If the baby’s heartbeat is not in distress, you can delay or refuse any intervention such as a hormone drip or your waters being broken. Ask what else can we try? Take advice on the day.

First time labours are often long, or are perceived as long. After all, the common reference for women nowadays about birth is what they see in the media, and those labours are done and dusted in a half hour time slot, if that. It can make women feel like their long latent phase is somehow abnormal. The average length of active labour for first time mums, according to babycentre is 8 hours, with the whole labour averaging 18 hours. Anecdotally, when you talk to your friends, they may say they were ‘in labour for days,’ which means they’ve counted it from the time of the first twinge, whereas the health profession will have counted it from active or established labour. You never know where you’re going to fit on the scale, so there’s no point worrying about it. Take each part of it as it comes and listen to your body.

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Early labour, latent phase, not in active labour or established labour. It doesn't mean you should be ignored. Read more by clicking on the image above. Were you ignored in labour, not allowed pain relief, or told you weren't in labour?

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