Labor can take awhile, especially if this is the first birth.  I anticipate 24 hours of labor for a first time birth, and I have served clients whose labors have lasted longer than 48 hours.  Sometimes a Mom who has had previous short labors can be in for a longer labor than she expects.  As a midwife, I want my clients to have the tools they need to handle a labor that goes on for a while, so I encourage all my clients to be prepared for a long labor.

My biggest tip is to ignore labor as long as you can.  The less energy and attention you give it, the more you will have to pull from when you really need it.  I've had clients use many different techniques to ignore labor.  Some go shopping, some cook or bake, I've even served a client who played video games.  

Keep your routine normal.  If you are in labor and it is your normal time to go for a walk, then go for a walk (you might want to go for a shorter walk, or have a pace that is slower than your usual pace).  If it is time to go to sleep than get in bed and try to get some sleep.  Even if you aren't able to sleep but you can rest and relax, that will be beneficial and let you have energy for the long haul. 

Keep your activity levels low key.  Labor is not the time to head to the gym to try a new HIIT workout or go outside and thatch your 1/4 acre lawn.  By being mindful of your activity levels, you will be in a better place to have the energy to finish labor strong.  When you are worn out at the end of labor, it can create challenges in the immediate postpartum such as increased risk of hemorrhage, difficulty getting up safely to use the bathroom, and you may not have the energy to truly soak in that you have a brand new baby in your arms.

Eat and drink.  Long labors require lots of calories to keep going.  I don't expect clients to eat full meals, but I do want clients to eat. Small, frequent snacks are what most clients do so have some easy snacks and light food on hand.  Some ideas are fruit, yogurt, cheese, jerky, crackers and nut butters, nuts etc.  Drink plenty of liquids to stay well hydrated.  Have a grazing mindset, and eat something every half hour when you are awake.  I also like it when whatever you are drinking has some calories.  Watered down electrolyte drinks, coconut water or homemade laboraide are fine ideas.  If you want to drink juice or soda, I'm fine with that too.

Sleep.  I know it sounds hard, but you can sleep during labor.  I've been at many births where the client is able to doze off between contractions.  I always find it interesting that if Mom is really tired and lays down, labor slows down.  The body recognizes the need for sleep and accommodates it.  If you can't sleep, but you can rest and relax between contractions, that is so very beneficial to replenish energy and get through to the end with some reserves.

Pace yourself.  To make it through a 24 hour or longer labor with some reserves to finish strong, you need to pace yourself.  By that I mean being active and working with your labor for an hour or two and then laying down to rest or sleep for 30 minutes to an hour.

Change the energy.  Long labors require stamina, endurance and sometimes a breath of fresh air.  You can go for a walk, talk to someone on the phone, take a bath or shower, write a letter to your baby, anything that builds you up, nurtures your soul and gives you a change of pace.

Long labors are not unusual, and do not mean something is wrong.  Unmedicated labor has its own pacing and for the vast majority of births, it's not a lickety-split pace.  Being prepared for a long labor will pay off  for you if your labor is like the majority of labors, and if it is fast you can still pull from the preparations you have made to get you through with plenty in the tank at the end.
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Cervical checks are one of the mainstays of obstetric care.  It is not unusual to get checked around 38 weeks even though labor has not begun.  Then you get checked at the hospital while they are admitting you when you are in labor.  You might get checked more than a few times during labor.  Why all these checks? Do they tell how much longer you will be in labor? Are they risk free? Do you do cervical checks in your midwifery practice?

Let's start with the last question first.  I do not do cervical checks as part of routine care in my midwifery practice.  If a client asks me to do a check, we will discuss the risks and benefits of checking before I actually do a cervical check.  In all honesty, I prefer not to check.  I use external cues to assess how well labor is progressing, and those cues have served me well during my midwifery career.

What are the reasons for cervical checks anyway? Before labor begins, a provider may use a cervical check to assess how likely it is a pitocin induction will work.  Sometimes providers want to know if dilation has started before labor has begun.  A check when you are admitted to the hospital is done to confirm dilation is happening during labor and can also be to show insurance enough progress has occured to justify admitting you.  During labor, many providers have an assumption of how quickly you should be dilating, so they check to see if your body is conforming to their assumption.

Cervical checks do not tell you how much longer until your baby is born.  They tell the provider how dilated your cervix is in the moment, and potentially how your baby's head is positioned in your pelvis.  A cervix can be at 4 cm dilation, and baby could be born in the next 30 minutes or less, or a cervix can be dilated to 9 cm and labor may last another 6 or more hours.  Honestly, I think medical providers feel the need to check dilation because they are not staying with you in the hospital as labor progresses, so they don't have the opportunity for assessing progress by external cues.

Cervical checks do have risks.  Cervical exams increase bacterial levels in the vaginal canal which might lead  infection, especially after the membranes have ruptured.  Even with the most scrupulous hygiene, and wearing sterile gloves for each check, that risk does not go away.  There is a risk they may unintentionally rupture the amniotic sac.  Cervical checks are uncomfortable and may cause stress or anxiety, which can slow your labor.  Cervical checks are subjective, dilation is estimated because we can't use a measuring tape to get a precise number, and the estimation may vary between providers.  I have seen this personally when the nurse estimates dilation at 7 cm, and the doctor checks within 10 minutes and estimates dilation at 5 cm.  Hearing that you have gone backward after hours of labor can be disheartening to put it mildly, and can cause unneeded stress.

I like to watch and wait for the body to let my clients know when dilation is complete.  Because cervical checks are uncomfortable, intrusive, have risks and don't give me big picture info, I rarely use them.  As a midwife, I understand each birth has its own unique pace and rhythm and my job is to support and nurture that, not try to manage it.
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