Express Delivery - Abnormal?

Author // Jacqueline Tsiapalis, D.C., FICPA

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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.

Pathways Issue 35 CoverThis article appeared in Pathways to Family Wellness magazine, Issue #35.

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