What to do in labor with a stall or no progress or just too much pain?

easierpregnancybirth
Mar 13, 2017
18 min read

Early labor is long but not painful

A long early labor concerns many women. It’s important to eat!

Eating foods that are easy to digest, soups, smoothies or yogurt are a few.xz A long early labor might occur for a woman who has had a few babies already.
A long early labor for a first-time mom or a VBAC mom may indicate a need for engagement. A long early labor sometimes means that this baby needs to rotate some more before fitting into the brim of the pelvis.

Engaging Baby in Labor

A baby cannot get through the pelvis if the baby can’t get into the pelvis. Lack of engagement is a common issue for the woman who labors but the baby remains high in the pelvis. For about half the cases, the uterus gets overworked trying to get a baby into the pelvis for days of labor. A common solution is to do a cesarean.

Spinning Babies offers a few simple engagement techniques that can be done in labor over the course of an hour or so. But once they are done, the labour is very, very likely to progress.

What does labor look like when the baby isn’t engaged?

Early Labor goes on and on
Or, labor doesn’t begin even after 41.5 or 42 weeks (engaging baby often starts labor in 24 or less hours)
Irregular contractions do not get strong enough to get into active labor though they can feel strong and occur over hours or days
Contractions may also be very, very strong and very grinding on the pubic bone
Dilation isn’t the predictive factor
The baby’s little forehead may be felt resting on top of the pubic bone like a small ledge

Scenarios with an unengaged head:

Early labor can go on for a day or two or three. This is because the labor can start and stop as the baby tries to get into the pelvic brim. Women may not dilate beyond 3 cm when the baby remains high.

Labor can feel so strong as the uterus works hard to rotate baby’s head to drop into the pelvis. These strong contractions can go on for days. Once baby engages labor becomes effective and the baby is born in 8 hours or less.

Other times, labor seems to begin and progress normally until a labor stall occurs in active labor or even pushing. In this case, labor started without stops and starts. The baby remains high during the stall in this case. When baby is not engaged the baby is -3 or -2 station.

Not all unengaged labors have these characteristics, but these are quite common.

Add balancing techniques to engage the baby and a sudden change will be felt

In labor, how to help the baby engage

We’d focus on engagement if baby were high, the baby were at -2 or -3 station AND the labor didn’t progress within a few hours of regular contractions. We could also try these techniques if the early labor felt strong and had a start and stop pattern (with strong contractions):

Ten contractions in a row doing the Abdominal lift may be the most effective technique during contractions.
Sitting on a firm birthing ball and doing rather rapid hip circles (hoola hoops) or figure “8s” especially if there are no contractions. Dip the Hip is perhaps an alternative if no ball is available.
Open the pelvic brim with Walcher’s “Opening the Brim” Position (only effective during contractions, and not typically “fun” so try Abdominal lift with a posterior pelvic tilt first unless an epidural keeps mom in bed)
Open-knee stretch in the pool (Inverted Walcher’s in the pool during 3 contractions).

What will labor look like when the baby is finally engaged after this kind of start?

Once the baby engages, perhaps because the baby rotated and dropped into the pelvis, then the labor often seems to stall. In this case, this is no problem. The uterus is resting. The mother can rest too, as long as her and baby’s vital signs are good.

Once the uterus is rested and the mother fed and slept, the labor will pick up. It won’t seem as painful as it starts up again and the contractions will be more manageable. Then they will get closer and longer lasting and the cervix will open in response this time. Things will be more predictable and as expected when the baby’s chin is tucked and the head fits the pelvis better.

Problems after engagement if baby’s head position wasn’t optimal

Baby can sometimes get stalled on another part of the pelvis.

If the baby drops but the chin remains up, though the baby is coming down, the labor might still take a long time, depending on pelvic shape. We may then have to help open the midpelvis (ischial spines) and outlet.

If baby is -1,0, or +1 station, then the baby is engaged but stuck in the midpelvis and you would do a Sidelying Release followed by side lunges for either a Transverse Arrest or an Asynclitic baby.)

The lunge is a wonderful technique for helping the baby when labor stalls at 0-station or below. The Hip Press and internal rotation of the femur as the mother, starting on hands and knees, lifts and rests her leg up over a peanut ball or somewhat deflated birth ball.

If the baby drops but the head is tipped, as if the baby is listening to the outside world, in an asynclitic position, then the labor will remain long. Opening the midpelvis the head to pass through helps (lunge, sidelying release). See the article on asynclitism in Baby Positions.

You’re having back labor

Tight ligaments, tight or weak muscles, or the baby’s position may be the cause of back labor.

If you know that the baby is facing forward (posterior presentation) or you have back labor in any case, there is a simple technique that works wonders. When you can anticipate a contraction coming (contractions have to be somewhat regular), begin an Abdominal Lift, also called a Belly Lift, and hold it during the contraction. Let go of your belly in between contractions. Repeat ten times as described on the Abdominal Lift page on this website. We expect that ten Abdominal Lifts (with a tucked pelvis during the contraction) will shift the force of the uterine action (contraction) from your back to your cervix. The baby is angled better as well. With success, the cervix will begin to dilate.

Labor is long and painful (i.e. you’re experiencing a stall in labor)

The length of labor is a separate issue than the pain of labor. A long labor with unexpected strength and perhaps no or slow progress is called a stall in labor. Its only a stall if after 4 cm, though we want to pay attention to why labor stops if before 4 cm, too, especially if the water broke.

Some women just need time in labor. But how do we know whether a laboring woman experiencing challenges or a stall needs techniques or just time? In labor, there is a series of techniques that solve most labor stalls, especially in the presence of contractions:

Rebozo jiggling (sifting)
Standing sacral release (if in bed, do an abdominal release)
Forward-leaning inversion
Pelvic floor release (also called the sidelying release)

If no contractions, sleep (without drugs if you can) and eat some oatmeal or other healthy carbs to restore a labor pattern.

Follow these up with a rest in a Rest Smart position, or when up, standing with knees soft (not locked) and leaning over a friend, a counter-top, etc.

You’re having a long early labor with stalls and starts

The mother may feel that her labor is going. Contractions may be strong and close, or mild and close together. But then they slow down. Then, later, they start up again.

The mother’s body may be ready, but sometimes with a posterior baby, the baby isn’t fitting into the pelvic brim. Labor wants to start, but the uterus just can’t get baby down into the pelvis. We need to help the baby to tuck the chin and then rotate.

Is the baby in an ideal or anterior position? Then let’s get the chin tucked! (with 10 Abdominal Lift and Tuck during contractions)

Once baby is engaged, the uterus may require a rest. As long as mom and baby have no clinical signs of trouble or fetal distress, a good nap is just the thing to protect the labor later. Go for the “snore.” Just “resting the eyes” isn’t enough to protect the stamina needed for later. After a good snore, have a bowl of oatmeal.

The uterus will pick up again once rested and fed. If baby has rotated and/or engaged, labor will start again.

Your active labor is long

A first-time mother can expect her active labor phase (the part of labor that opens her cervix from 4 cm to 10 cm dilation) to last from 12 to 24 hours. If labor is shorter, great.

Labor can be longer than expected when:

Baby has come into the pelvis in the posterior position
The posterior or anterior baby has the chin up a bit
The mother isn’t nourished, rested, or doesn’t feel safe/uninhibited in her location or with the people with her, or
The baby is large for the mother’s pelvis.

Again, we want to protect the health of mother and baby with food and rest for the journey. She doesn’t have to be constantly reminded to eat and drink, but watching the clock discretely and making sure she’s eaten a 1/2 cup of food or so every couple of hours is a minimum once she’s passed 6-8 hours of labor. Eat during a lull. Sleep during a lull.

Emptying the bladder is important, too. If baby remains high, ask the nurse or midwife (if she isn’t already) to monitor how much urine is actually coming out. Monitor the “ins and outs” of labor!

Your pushing stage is long

First of all, if the cervix is fully dilated and the mother doesn’t have an urge to push, suggest a Rest Smart position and let her sleep! When she wakes, feed her!

Emotional support during second stage can help a woman trust the downward pressure sensations and reduce resistance to letting the baby descend and come past the rectum and onto the perineum. These can be overwhelming sensations and reassurance and a practical attitude are helpful.

Let the urge come on and teach the mother through natural body sensations when and how to push.

If necessary, change positions to encourage the urge and the opening of the pelvis. Gravity works.

Opening and moving the pelvic joints is helpful during a contraction.

Time is less important than good breathing habits. Holding the breath frequently gets to be harmful after a while. When baby is getting good oxygen exchange between the contractions helps baby’s stamina.

An experienced midwife and or physician can help a woman through a long second stage. I’ve heard of 24-hour second stages with active pushing stages of 5-8 hours with great outcomes. But time is less important than listening to the baby.

A long second stage needs skilled help by an experienced midwife!

Nutrition is almost always easier during 2nd stage than 1st stage (dilation) so offer food again. Resting is an option. And changing positions frequently is smart. If its not working, try something different!!

You have a swollen cervix

Too often a swollen cervix sends birthing women to the operating room. Here’s what to do about it.

The cervix opens like an oval ring getting wider and eventually more round as the baby’s head presses down during fetal descent in labor. Effacement of the cervix is when the cervix gets thinner. Thinning out helps the cervix to open. Because we expect the cervix to get thinner, it can be alarming when the cervix stops opening and swells.

Swelling with contractions and without progress is a sign that labor progress has stopped or stalled.

The swelling may be equal all around, but is usually unequal.

Swelling in the front of the cervix is common and usually resolves with time for flexion and molding. Sometimes help to flex the baby’s chin is desirable!
Swelling all around is not so common and usually means the baby may need more help than simply time.
Swelling on one side indicates that the head is asynclitic. Do the sidelying release for both legs for any of these, but particularly for this one! Afterwards, lay on the side that the swelling is thicker.

The uterus continues to contract, trying to correct the baby’s position. The baby may be

Occiput Posterior
Asynclitic (tipped head)
Deflexed (head is in a military presentation or has an extended chin)

The baby may or may not be able to fix this spontaneously. Time without helping baby to fit may only stress the womb or baby. But when we understand the need, we can begin to address the issue more intelligently.

Necessary changes include flexion, rotation to a better position, and/or molding better to fit.

Interventions

When the cervix is swollen, the knee-chest position helps. We can also apply a small amount of ice in the finger sleeve of a glove and apply to the cervix.

Another option is to put Homeopathic tablets of Arnica and or Cimicifuga on the cervix and give orally according to directions. It must be the homeopathic versions of these herbs to be safe and appropriate.

Quiet the environment and let the birthing mother rest on her side in a deep tub of water between 94 and 98 degrees Fahrenheit. A mature and soothing woman to reassure her and help her doze helps her mind calm down and the cervix to open.

An experienced doctor, midwife or, possibly, nurse (if local protocols allow) might be available with skills to flex and rotate the baby’s head if these things don’t work. An epidural may not solve the swollen cervix, but may be offered in the hospital.

A cesarean is offered or recommended when the labor doesn’t resume within two hours. Yet, this situation can easily take that long or a bit longer to correct itself using the above position changes and ice.

Note: A stall is not necessarily CPD

A stall in labor is when contractions come strongly but the cervix doesn’t continue to dilate. (A lull is when contractions are milder.) CephaloPelvic Disproportion (CPD) means the baby’s head is disproportionately big for the mother’s pelvis.

A stall in labor with a swollen cervix is NOT IN AND OF ITSELF reason for a cesarean.

Swollen cervixes will become unswollen when the head shifts and allows circulation. We can also move the mother to improve circulation.

The cause of the stall with swelling is often a need for further flexion and rotation for the baby to line up with the lower portions of the pelvis. But we cannot forget fear or disturbance of the birthing environment as a causative factor.

You have an early urge to push

It's believes it is uterosacral ligament tension that causes the early urge to push. There may be deflexion (chin up) or Occiput Posterior presentation with that tight or twisted ligament. To help, follow the 3 Principles!

Principle 1, Balance

We want to “make room” and “add balance” first:

A Forward-leaning Inversion through 3 contractions, followed by a sidelying release.
A pressure point massage around the edges of the sacrum, and again around an inch margin from the sacrum’s edge, helps mobility.
Finally, some women will benefit from a sacrotuberous ligament release, which is quite specific and intimate, even though external.

Principle 2, Gravity

Knee-chest with the mother’s chin up, tongue out and panting reduces her body’s spontaneous urge to push.

Principle 3, Movement

With the same knee-chest position of the mother, add a rebozo scarf over her bum and “shake the apple tree.”

Interventions

A knee-chest position reduces pressure on the cervix and the posterior portions of the pelvic area including the uterosacral ligament. This can reduce the urge to push.

Extreme panting: I learned this technique in The Yoga Journal. The woman puts her chin up and sticks her tongue out as far as she can and pants through the contraction. This posture with the tongue out prevents downward pressure on the cervix. It’s awkward, but it really works

The premature urge to push can be a real annoyance. Pushing on a cervix that isn’t ready may tear it, although that’s rare. Pushing early sometimes causes cervical swelling.

We can move the mother to reduce her urge to push until her cervix is fully opened (or so soft it slips over the baby’s head if it is almost fully open). A knee-chest position is often helpful, though panting with the tongue out may still be needed!

In Labor Now

Are the following happening?

Strong labor seems to start and stop, or surge and withdraw, for some hours to days
Surges come on at any time
Contractions may be long and irregular, but strong for hours and then fade away
Pattern occurs with or without back labor
An internal exam reveals that baby is still high in the pelvis

Baby might not be engaged. For some, the uterine action to engage baby seems like labor, sometimes as strong as labor associated with transition. But the baby isn’t even on the cervix.

When the baby is not engaged in the pelvis the uterus works very hard to try to get the baby into the pelvis.

The pain is on the pubic bone, but can also be felt in the back or rectum. When baby moves, baby may “grind” the forehead on the pubic bone trying to rotate away from the front of the pelvis. Sometimes there isn’t pain to give a clue.

The cervix is often open less than 3 cm in a first-time mom. But don’t rely on the cervix! Sometimes women open all the way to 10 cm and yet the baby hasn’t come into the pelvis.

If the baby isn’t engaged, the nurse, midwife, or doctor may say the baby is -3 station. This unengaged posterior baby often must rotate to left occiput transverse before engaging. Spinning Babies techniques aim to help rotation. Rotation may solve the problem to let baby engage and descend through the pelvis, helping the mother potentially avoid a cesarean.

The mother can check her own abdomen for a little tell-tale “ledge” resting on her pubic bone. If the ledge is there, it’s usually baby’s forehead. Then we know contractions may start and stop until the baby is turned.

High in the pelvis might also be termed -2 station (2 cm above the halfway point of the ischial spines).

When baby is directly posterior the back of the head might be felt in the pelvis at -2 and the provider thinks the baby is engaged. This is also because the head won’t wiggle. If the forehead overlaps the pubic bone then the forehead isn’t in the pelvis and the baby isn’t truly engaged.

Spinning Babies has the solution for many women in this situation:

3 Sisters of Balance relaxes the mother’s abdomen and makes room for fetal rotation.

Rebozo sifting
Forward-leaning inversion through 3 contractions
Sidelying release through 3 contractions on each side

Now the laboring woman can often rest. Labor may be mild for an hour. She can snooze.

Surges begin again. If a woman isn’t pushing her baby out, she follows the 3 Sisters with the techniques to match pelvic level.

Baby still high? We balanced, now we reposition the baby for flexion! Do the Abdominal Lift and Tuck through a contraction for 10 contractions in a row. Let the belly down and relax the back in between contractions. Doing the Abdominal Lift with a posterior pelvic tilt to flatten the lower back and move the sacral promontory out of the way will help baby to tuck the chin and rotate out of posterior and descend.

Or, Baby is Zero, “0,” station, in the midpelvis, or +1, +2 station, lower down in the outlet. Either way, strong labor isn’t progressing labor. Do 3 lunges on each leg, resting between contractions.

The 3 Sisters is the most powerful contribution of Spinning Babies to the birth world. These Sisters work to balance the pelvis in pregnancy and in labor. Starting balance in pregnancy may mean you won’t need them in labor. Starting balance in pregnancy may mean you don’t end up with a crisis in labor to a stalled labor or a case of “baby won’t fit.” Some women may need more specific balancing activities.

Pre-Labor or Early Labor when contractions are irregular

Length 20-40 seconds but not consistent

When baby isn’t fitting well, these contractions can be 60-120 seconds with no dilation. One sign can be that the labor pattern is erratic. But don’t make an assumption, please! It can be difficult to tell this situation from transition without a vaginal exam. See Comparing OA and OP Labor Patterns for more details.

In this situation, these can help:

Relax the abdomen with Rebozo “sifting” (Manteado)
Laughter & love!
Warm chamomile tea
Acupressure
Acupuncture
Chiropractic adjustment
Sit Smart, with your back straight or a little forward to help the baby settle in the front of your abdomen
Abdominal and sacral releases

Early Labor when contractions are regular

Frequency 4-10 minutes apart; length 20-45 seconds

Bloody show possible

Relax the abdomen with the same things listed in Pre-Labor. Wait on the tub.
Maintain regular daily routine (special considerations if water broke). Eat every two hours and drink water, electrolyte drinks, a little grape juice or hibiscus tea (for example) each hour.
Rest Smart when tired, walk or slow dance, lean forward by, for example, washing the floor on your hands and knees.
Use Gravity with the Abdominal Lift.
Hands and knees or kneeling over the back of a couch or hospital bed. Or, kneeling on pillows and resting your arms in a comfy chair.
Move: Lively hula-hoop circles on the Birth Ball for 20 minutes.
Stand and lean forward in the shower if sitting is painful, do pelvic circles while standing.
Check in with providers to let them know potential for labor to bring you to the hospital (or them to you, if having a home birth). Call the doula! Doula-supported labors are statistically shorter than labors without one.

Active Labor – beginning about 4 cm

Frequency 3-6 minutes apart, from start to start; length 60-75 seconds from start to finish of the majority of contractions

May need quiet, dark, privacy
Continue to Rest Smart when tired and use the relaxation methods in Pre-labor. Massage between contractions.
Rebozo sifting for serious relaxation.
Movement: Walking can help contractions continue to come. Be sure to eat, too. Slow dancing is more for relaxation and not that dramatic for progress. Circles on the Birth Ball. Lunge for one-sided pain, asynclitic head after 4 cm, or just progress when slow.
An inversion of one type or another, your preference, may help, followed by the Trochanter Roll (Walcher’s Maneuver) if the baby isn’t in the brim before that.

Active Labor – 5 cm (or 4-6) “Five Centimeter Slump”

Frequency 3-5 minutes apart; length 60-85 seconds

If you cope through 5 cm, you’re likely to have a natural birth!

Relax your involuntary muscles as described before. Or, if you have a loose, pendulous womb, wear the pregnancy belt during your entire labor. Rest Smart when tired.
At any time in active labor (through the next three described phases) you can
1.) Do a sacral release,
2.) Do the inversion through three contractions, then,
3.) Do a pelvic floor release.

Afterward, you will probably want to sink in a full tub or take a warm shower to mentally relax after those three techniques which can be challenging this far into labor, but amazingly effective.

Abdominal Lift and Tuck as before, do for 10 contractions in a row, resting between. Lunge for 6 contractions on each side. I like to do 3 contractions on one side, then switch knees, then repeat, rather than all 6 on one side.

Showering is very useful, maybe while sitting onbirth ball, or leaning forward.

Feeling dispair? Or, labor is just very intense?! Time for a tub bath.

Stand and hang on to your partner’s neck. Stand and hang on to a sheet thrown over the bathroom door-tie a knot in one end and throw the knot over the door, then shut the door with the knot on the other side. Now the sheet won’t slip off the door and you can hang on the sheet and bend your knees and move to the contraction.

Lift one hip and put one foot up. For instance, when sitting on the toilet, put one foot on a stool, or anything the right height, for three contractions. Stand for one with your other foot on something. Sit for three, stand for one, again.

Movement: Slow dancing or slow dancing in the shower with the wall, or grip bars, while partner sprays your back with a warm stream of water from the shower hose.

Active Labor – advanced 6-8 cm

Frequency 3-4 minutes apart; length 60-85 seconds

If not at birth site, now is a good time to go!
Balance: as before, plus, relax the throat by “cooing.” Deep, low tones are usually better than high-pitched tones to relax the throat.
Gravity: Lots of moms like to be low to the ground…and they feel grounded with their knees deeply bent. Kneeling on the floor while leaning forward, for instance, or crouching down.
Need to speed things up? Sit on a toilet for three contractions, then stand for 3, and then sit for 3 contractions again. Shower or tub. Birth Balls are rarely desired this late in labor, but if so, go for it.
Movement: Lunge, if you haven’t before, or try again for 3 contractions on each side, repeat. Walking can still be helpful, but may not be practical. Put one foot up on something when standing. Have your knee out to the diagonal and a foot on a stool.
You will know what you need as your body feels progress. If you feel lost or frustrated, return to a calm and do sidelying release on both sides followed by shake the apple tree (see techniques).

Active Labor – Transition 8-10 cm

Frequency 2 1/2-4 minutes apart; length 75-120 seconds

Bloody show likely, even if seen in early labor or before labor

Balance as before: Inversions are a common success for the stall in a posterior labor. Use of a doula and face-to-face support is commonly appreciated. Loud moaning to a rhythm and a cool cloth can also help.
Gravity: Standing and leaning forward, Rest Smart when in bed. Birthing sling. Stand and hang on to the Rebozo or give the squat bar a try through 3-6 contractions.
Movement: Lunge, holding Rebozo or sheet and straightening back. Bending knees with contractions and moving freely. Baby still high? Trocanter Role with Walcher’s Maneuver. Pelvic floor release.

2nd Stage – Pushing or Releasing

Frequency 3-5 minutes; length 45-75 seconds long

Balance: Be upright, with your back long and extended. Don’t curl your back. When labor is not progressing readily, let your back be straight the way it naturally wants to lengthen. Sit up on a toilet (the porcelain birthing stool), lay on your side with your back arched instinctually, or stand and lift your arms to hang onto something sturdy above you.
Relax well in between contractions. Let the contraction get started before pushing voluntarily. If you need to push, use exhale pushing to conserve strength or mental stamina. At the end of each contraction, take several deep cleansing breaths. Smile and feel the joy. Make deep vocalizations, vowel sounds or roaring as desired. Kiss your lover. Know that your baby is helping you by pressing that pain out of your body. Work as a team. Let the baby rock back and forth in your pelvis; this relaxes the tissues in the perineum.
Gravity: Vertical positions or side lying on bed to open the pelvis. “Towel pull” squat for 3-6 contractions, hot washcloth on perineum for privacy, cold wet washcloth on anus to prevent or soothe hemorrhoids.
Movement: Rock forward and back while kneeling and leaning over a ball or raised head of the bed. Lunge if baby is asynclitic.

Confined to bed?

Some providers persuade or direct all their moms to stay in bed during labor. Sometimes a woman’s health is such that she has to stay in bed. Keep rotating the pelvis. Lay on your left side with a pillow between your knees or lift your right knee high up on a stack of pillows and shift your left hip back behind you, so to speak, so your belly aims in the mattress. Use pillows to support what needs supporting.

Switch to your right side and try each of the variations. If you can kneel and lean over a birthing ball or the raised head of the bed, do so for 30 minutes between sides. Each thirty minutes change positions.

If your labor starts progressing rapidly, don’t worry too much about position changes for the purpose of labor progress. On the other hand, if labor doesn’t continue to progress, try and keep your back straight, not curled!