Editor's Blog

Early Labour is a Key Area for Attention

On Sunday, I attended a pre-meeting of the Normal Birth Conference at Granger-over-Sands in beautiful Cumbria. Researchers from Canada, Germany, Switzerland, England and Scotland gave their attention to the vexed question of ‘how to get early labour right’. That is, how to help women (and midwives) cope with the uncertainty of early labour, to manage it, wherever possible, at home and to avoid women being admitted to hospital when they still have many hours to go before their babies are born. Getting early labour right is key because we know that the longer women spend in hospital, the more likely they are to have interventions.

The issue of educating women about early labour was broached. And as part of this discussion, the question was raised of what we should tell women about how long the latent phase might last. If we define the latent phase as extending until the cervix is four cms dilated, how long do we think it should take a woman expecting her first baby to reach that point, or a woman expecting her second or subsequent baby? Is there a range of the normal? Can early labour be ‘too short’ or ‘too long’? How long would ‘prolonged’ early labour be?

Another question then arose as to how to define the start of labour. Should we say that labour starts when the woman says it starts? Or from when she says she started having contractions? Or from when a health professional says it started?

Is it best for childbirth educators simply to invite women to share their stories about how labour starts – their own and other people’s stories? If we attempt to define a start-point, does that devalue women’s own knowledge of their bodies? (I myself knew my first labour had started simply because I ‘felt different’.) And what are the dangers (if any) of putting a time-limit on early labour – even supposing it’s possible to define both the ‘start point’ and ‘early labour’ itself.

These may seem rather abstract questions, but if you’re trying to devise an early labour service that works both for women and health professionals, they are very pertinent ones. My instinct is always to ‘leave labour alone’ and simply listen to the women, but I do appreciate that this may not work very well when trying to implement new services with the cooperation of midwives, obstetricians and health managers.

From my own experience of leading antenatal classes, I know that many women and pretty well all of their birth partners want to know ‘when to go in’ (to hospital). The freedom from this particular worry experienced by women who have chosen a home birth is frequently noted by group members. But home birth isn’t a choice that everyone can make or wants to make. So what’s the answer to ‘when should we go in?’ I used to say, ‘when you feel you need to’. Perhaps that was simply fudging the issue, and not at all helpful.

There will be those of you reading this blog who strongly resist any talk of ‘early labour’ saying – very reasonably – that labour is a continuum and that the labels we attach to it: ‘early labour’, ‘first stage’, ‘second stage’, ‘third stage’, are entirely arbitrary and do not in any way reflect nature’s process or women’s experience. However, while women birthing at home may experience labour as a fluid process, the majority now experience it according to the terminology used by health professionals. Which leaves us with the question of ‘when (and how) does labour start?’ ‘What is early labour?’ ‘When does it come to an end?’ and ‘When should we go in?



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