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precipitous labor

Birth: Expect The Unexpected

Certified Nurse Midwife Anne Margolis discussed what happens when labor does not go as planned. She talked about the importance of understanding what a cesarean section is and why it's important to know what happens in case of an emergency.

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When it comes to birth, oftentimes things don’t go as planned. Sometimes this means a woman never makes it to the birthing tub she prepared, filled up and dreamt about birthing in, because in the moment of giving birth, she found her groove and prefers to stay on the squatting stool or her labor progresses quickly, and she needs to push before the tub is filled with water. Sometimes this means certain family members or friends aren’t present for the birth like originally intended because for example a mama is not laboring well with her kids present, they want to leave, or her best friend is sick and could not come to help.

Other times, when things don’t go as planned, this means a woman might need medical or surgical intervention. A common example: a mama is experiencing a hard back labor at home or free standing birth center, her baby persists in the posterior position, she is not progressing for hours despite trying everything and is exhausted; she is transferred to the hospital for Pitocin to augment her labor and the compassionate use of an epidural. A less common example is baby is not tolerating the labor, and is showing signs of worsening distress in any birth setting, and a cesarean is needed to save baby’s life.

Photo by Mary Elliott O'Haire

Photo by Mary Elliott O'Haire

Overall, we must surrender to the process of labor and birth and know that we are being guided and well cared for. To avoid needless suffering, we must embrace what comes our way that is not in our control, as what is meant to happen – because it is happening or did happen; and we can raise to the level of being grateful that we were given exactly what we needed for our benefit, what we each needed on our own journey as a soul temporarily living in a body, even if we do not understand the whys. I am not apologetic about my spiritual perspective and my firm belief that the infinite all powerful being, Spirit or G-d of our own understanding is pure goodness and love for each and everyone one of us.

I’d like to address a question I get asked frequently.

Art by Catie Atkinson @spiritysol

Art by Catie Atkinson @spiritysol

Why do I mention cesareans in my online posts?

Cesareans can be both planned and unplanned for serious complications or illness. In both cases, they are indeed a birth. They are a birth for baby, a birth for mom, a birth for dad, and a birth of a new family unit.

I want all women to feel lovingly supported and cared for however they birthed and that includes a cesarean.

Art by Catie Atkinson of @spiritysol.

Art by Catie Atkinson of @spiritysol.

I like to post information on what I refer to as a gentle cesarean. It’s still using a home birth model of care, with the principle of restoring humanity to maternity and newborn care – especially in the operating room. A gentle cesarean would include possibly pulling the curtain down, allowing the baby to birth itself gently through the incision, encouraging mom to receive her baby directly from the surgeon, hold her baby skin to skin, delayed cord clamping and early breastfeeding; it can also include allowing her partner, doula and anyone else she needs in the OR by her side.

I want to offer support to all women, and especially women who feel their birth did not go as planned. Although it’s rare for normal births to lead to complications or emergencies requiring life saving medical and surgical interventions, most births don’t go as initially planned.

Photo Credit: @albanydoula

What do I do when things don’t go as planned?

In general, healthy mamas with healthy pregnancies have healthy births. The stats on homebirth  and free standing birth center outcomes are excellent when there is a trained experienced midwife in attendance.

My transfer rate from home to hospital in labor is 7% and that is comparable to those of my colleagues. The vast majority of transfers are non-urgent. In most cases, it’s usually first time vaginal birthers whose labor stops progressing with exhaustion despite us trying every one of our "tricks" to remedy the situation. The need to call 911 and have an urgent ambulance transfer has been a handful of times in 20 years.

The midwife is of course there as a lifeguard - as rarely emergencies do occur. I bring the same emergency equipment and medications that any free-standing birth center has. Most of the time I don't use it and all is well. But when I need it, I have saved lives, as any seasoned midwife can say.

I saw much more catastrophic events when I was an OB nurse in the hospital. I have never lost a mother, but our country's maternal mortality rates are among the highest compared to most modernized countries, and this is largely from risky hospital interventions, which are not happening at home.

I have had to resuscitate significantly less babies at home – we have a screened healthy low risk population, are watching closely and WITH the mama in active labor. We do not intervene unless medically necessary and do not cut the umbilical cord until it stops pulsing or placenta is birthed, unless there is a problem or a request for lotus birth.

In 20 plus years of homebirth midwifery practice I have had to transfer 3 babies to the hospital who did not respond to resuscitation and needed intensive care due to unrelated complications, and this is significantly less than our country's high newborn morbidity and mortality rates.

Yes, we need to be prepared for and have to manage a rare shoulder dystocia (stuck shoulders) but it happens less as our mamas are laboring and birthing in positions that use gravity and maximize the diameter of the pelvis. Yes we have had to treat postpartum hemorrhage not responsive to natural remedies, with medication and IV fluids.

Not to offend animal lovers and vegans, but this moose provided a perfect home "IV pole" for a mama who needed intravenous fluids during her homebirth. Homebirth midwives must be creative.

Not to offend animal lovers and vegans, but this moose provided a perfect home "IV pole" for a mama who needed intravenous fluids during her homebirth. Homebirth midwives must be creative.

I do not convince anyone to have a homebirth as it needs to be each mama's decision. I do provide information so she can make an informed one. She needs to birth where she feels safe or she won't labor well. 

It is one of my passions and areas of expertise to help mama's with these sorts of questions. I offer online consulting for mama's just like you, whether a one hour discussion or a package of consultations and email access from pregnancy through postpartum – which is great for mamas who want and need more personal attention and guidance to a holistic midwife as they have no access to one in their area.

To really best help a mama make a decision unique to her situation - I recommend a conversation. This is not something simply answered on social media, without discussion.

If you want to schedule an online consultation, please go to my website:  - I look forward to connecting more and answering your personal questions.

Photo by Megan Hancock Photography

Photo by Megan Hancock Photography

Let Me Help You Create The Happiest Birth Experience Of Your Life...

Whether you're a first time or experienced momma,

Or a midwife, doula, or birth professional guiding mommas..

Regardless if you are planning a birth at home, a hospital, a birth center or need a cesarean section, or if you are taking another childbirth education class…

You Really Can Create The Delivery Of Your Dreams.

And have a blissful birth wherever you are.

More Precious Than A Wedding...A Birth Should Be A Celebration!

Let me show you how to…

  • Understand the sensations of your body and connect your intuition with how your body is communicating and leading you towards what to do during labor

  • Tap into your inner calm to deeply relax yourself,letting go of busy, stressful and fearful thoughts on demand for the health of baby

  • Speak your truth from your heart in a way that deepens your relationships, sets clear boundaries, and has people listen to you and support you before, during and after pregnancy

  • Trust yourself, connect with your body wisdom andcommunicate with baby in belly

  • Connect with natural time and sync your body and mind up with your unique biological clock for ease from pregnancy to postpartum

  • Reprogram negative patterns, stories, and beliefs that undermine your confidence, strength and self trust so you can rock your birth

Physicians and midwives around the world recommend my teachings to their pregnant clients and many Doulas across the country learn the secrets of blissful birthing from me to supplement their Doula Training & Certification process!

To learn more, visit:  LOVE YOUR BIRTH Online Childbirth Course!

It is based on my years of experience, as a midwife and yoga teacher, helping thousands of women tap into their calm and live and birth from a place of grounded relaxation and joy. 

Check out my pregnancy herbal tonic recipe and some of my favorite supplements I recommend below, to augment a wholesome healthy diet, so you can meet the increased needs of your body and your growing baby.

 

Do you need supplements? Here are some of my favorite I recommend to mamas in my practice.

Make your Red Raspberry Leaf and Nettle herbal infusion.....rich in needed nutrients and specifically nourishing for pregnancy, birth and postpartum. Place 1 oz of dried red raspberry leaf, 1 oz of dried nettle leaf in a quart-sized glass canning jar with strainer, fill it with boiling water, cover and steep for at least 2 -4 hours at room temperature. Strain and place in a covered pitcher. You can make it in larger quantities and store in the fridge. For taste, dilute with water or steep for less time (but no less than half an hour), add lemon or lime juice, mint leaves or a teaspoon of honey. Drink 1-4 cups daily hot or cold.

Precipitous or Rapid Birth

CNM Anne Margolis talks about what to do the baby is coming before you can reach a care provider - also known as a precipitous labor / rapid labor. Subscribe to Ask the Midwife Newsletter: bit.ly/askthemidwife

What is precipitous birth?

Precipitous birth is medically defined as a birth that occurs in three hours or less— from the onset of regular labor pattern to baby being born. Sometimes, though, it can happen much more quickly than that — two hours, one hour, even 30 minutes! It tends to happen more often in second and subsequent births, but it can happen to a first-time mama too! A mama can also be in earlier stages of labor but rapidly progress to later stages and pushing.

Is it dangerous?

There are some potential risks, which is why it is important to get help; but in the vast majority of cases, the outcome for mom and baby is good. Normal, natural births are not considered emergencies. Precipitous birth is a variation of normal and natural — it’s just crunched into a smaller timeframe than usual!

What do I do if it happens to me?

First and foremost, stay calm! There is no need to panic. Take a deep breath and feel yourself grounded on the surface you are on. Remember your body knew how to grow your baby, it knows how to give birth, and your baby knows how to be born. Connect to the divine, to the spirit of your own understanding, and know you and your baby are guided and protected. It never hurts to say a prayer for the wellbeing of you both. You can act more effectively when calm and it is ideal to bring baby into an environment that is peaceful and gentle. If you were planning to go to a hospital or birth center, but you are feeling like you’re ready to push, don’t get in the car. It is safer to have the baby at home than on the side of the road. Instead, find a comfortable spot to labor in and have your partner call 911, and then call your care provider. Ask your provider to stay on the phone until help arrives. If you were planning a home birth but haven’t called the midwife yet, call your midwife, and keep her on the phone or Facetime until she arrives. Then find your comfortable spot, and ask your partner to put water proof padding under you, such as a flannel backed table cloth, comfortable flannel side up, or even a shower curtain, with Chux pads or cloth versions of them on top.  Remove your pants and underwear. Your care provider will hopefully stay on the phone with you and guide you as you birth your baby. Have your partner gather clean blankets and towels for the baby.

Are precipitous labor sensations much different than those of a longer labor?

This is subjective, some mamas love their fast birth and are grateful for the surprise and that they were not in labor for a long number of hours. Some mamas can find themselves overwhelmed by a labor that ramps up quickly with little warning. It might seem harder to cope when she hasn’t had time to process what’s happening. It is helpful for the partner to remind her that things are progressing quickly because everything is going right. Helping mama into a side-lying position or hands and knees can help slow things down slightly and give her a better sense of control. Help her tap into her slow deep breathing to keep her relaxed, and when pushing, pant through pursed lips to not only help slow things down, but prevent tearing as baby is emerging. Tension and fear not only don't help anyone, they make things worse. It is important to stay calm, take some deep slow releasing breaths, feel yourself on the ground or whatever is beneath you. Find your center. And remember, birth works the vast majority of times or we would not have survived as humans; it really is an instinctual process - mamas's bodies know how to give birth and babies know how to be born; we just need to get our minds out of the way. As renowned midwife Ina May Gaskin says..."Let your monkey do it."

PPhoto credit:  @marivette8

PPhoto credit: @marivette8

Is there any way to predict if I will have a precipitous birth?

There is no real way to know if you will have a very fast labor, although it is more common in mamas who have given birth vaginally before. If you had a fast labor with previous babies, it is more likely you’ll have another fast labor, and you should prepare for one. If labor begins and contractions are quickly close together (i.e. every few minutes for a first time mom or approximately every 5 minutes for a subsequent vaginal birth), lasting 45 seconds or longer and feel intense enough that you can not talk through them, make sure you don’t wait to contact your care provider. Also, keep your provider updated with changes in a “normal” or fairly typically progressing labor, and definitely if your main bag of water breaks and the amniotic fluid releases.

Image by Megan Hancock Photography

Image by Megan Hancock Photography

What else can I do to prepare myself?

Don’t forget to check out my LOVE YOUR BIRTH Online Childbirth Education Course! With 10 educational and empowering videos, and many bonus materials, it is everything you need to prepare yourself for the birth YOU want, to feel confident and empowered for however your birth unfolds, and not only ROCK, but also LOVE your journey. There is whole section devoted to you and to your partner about this topic in much more depth, so that you are both prepared for the most exciting adventure of a lifetime. Learn more here.