The Journey Begins
I was absolutely elated to be welcoming our first child. Everyone had told me to make a birth plan, and for some reason, I did not feel the need, thinking that whatever occurred organically was the order in which the birth should take place. I had very simple plans: I would birth naturally, with no epidural or induction, and with my doula and my husband by my side, we would welcome my son into the world. I had read enough about birth, taken my child labor class, and I felt well prepared. I was not interested in over-educating myself, because I felt like instinct should play a part. I know now that even if I had read every book I could get my hands on, I still would never have learned about prodromal labor, what it was, or how to recognize it. It was a condition I would experience during the births of both of my children, and yet, the term was one I would not learn for almost two more years.
It was December 2008, and I started labor slowly. Over the course of the day, my contractions progressed to be about 15 to 20 minutes apart, coming in strong groups, then calming. By the following afternoon, about 24 hours later, contractions were about 12 minutes apart. I waited for them to come closer together, and my doula came by to check on me. I was only 1cm dilated, so we waited for another day until they reached five minutes apart. I was completely shocked at the intensity of the contractions. What was odd was that they would get close together, then slow again after a few hours. The pattern didn’t resemble anything I had been told to monitor when determining true labor. I tried to keep relaxed as I felt my body pressing down on itself, seemingly trying to turn my insides out. I have an extremely high tolerance for pain, but this was unlike any pain I had ever felt. I was grateful that we had reached this moment, and that labor had finally begun.
We headed for the hospital and were met by my doctor, who I liked very much. I was excited for him to assess the situation. None of us could believe it when he said I was only 1cm dilated. I told him I had been in labor for almost three days and asked how this could be! He was stumped. Told me sometimes it happens this way. Offer #1 for an epidural came (there would be many more, from every hospital staff person with whom I spoke). I adamantly declined. He said that, at times like this, he can speed up labor by reaching in and manually stretching me open, but tended to only do this under an epidural since it was extremely painful. I told him to do it anyway. I did not want any drugs. The pain was surreal. But we were on our way. My contractions continued, and the nurses put a monitor around my belly to make sure the baby was okay. Several hours later, my doctor returned to check on my progress.
I was still at 1cm! I absolutely could not believe it. I was really hungry! And frustrated. And baffled, as was my doctor. He said all we could do was wait. I was about to begin day four of labor. He suggested that perhaps we throw Pitocin into the mix to speed contractions. At this point my contractions had been three to four minutes apart, during which I would bury my head into my husbands chest and he would rub his hands down my spine, trying to lessen the intensity. I had no idea how bringing the contractions closer together would make me feel, but at this point I was willing to cooperate and see where it took us, since nothing seemed to be working.
My doula gently advised me to wait, telling me that sometimes one intervention could lead to another (meaning a potential c-section). I heeded her words, but hours later opted out of desperation to try the Pitocin, bringing my contractions 60 to 90 seconds apart, with each lasting at least 30 seconds. I continued that way for about five hours, and by 11pm, I collapsed in tears on the bed. I was so tired, and I felt I couldn’t do it anymore. I was trying to be a hero, but for whom? My goal ultimately was to deliver a healthy baby. My body, it seemed, was retaliating. I had not planned on turning my fate over to the doctor, though here I was with my own course of action yielding no result.
I remember it like it was yesterday, even though it has been four and half years. My doula again urged me to wait a bit longer before making any decisions. Eventually, though, I buckled under the strain of so many days without sleep and pain that, even now, I cannot find words to describe.
By midnight, I asked for an epidural. At four am, my doctor came back to check me. I was 2 cm. He suggested we schedule a c-section for 6 am. I was so exhausted. My spirits, despite everything, were still high. I was so optimistic, still making jokes and trying to be lighthearted in the face of what secretly had been my worst fear. My doctor would be going home at 8 am, he told me. I could hold out, or he could deliver the baby via c-section at 6am. I asked him if we could wait and check again at the time of surgery, hoping that if I progressed, we would hold off. He agreed that this was a good plan. At 6 am, however, my status was the same. We prepared for surgery. I remember I was shaking so much, teeth chattering, and I could barely talk; like a shivering child just out of the bathtub. I don’t know if I was scared, or cold, or…what.
My husband and I held hands during the surgery. Tears streamed down our faces during the immeasurable joy of meeting our beautiful, perfect little Oliver for the very first time. I was still shaking. They closed me up, and I held our son. We had our baby, and that was all I cared about. I thanked G-d and felt everything was right in the world. I didn’t care that I’d had a c-section, because I had our son in my arms. As I nursed him and kissed his tiny little mouth, I felt like the most fortunate person in the world.
I still never knew that what I had experienced was prodromal labor. No one told me. Everyone seemed amazed to hear I’d had such a lengthy effort. But not even my doctor addressed in my follow-up appointment that what I had experienced had a name, not to mention that there was a positive way to navigate around it should it reoccur. Never mind, I thought at the time; I had no reason to be ungrateful. I was blessed.
The Second Time Around
Fourteen months later, I became pregnant with our second child. After my first appointment with my OB, where he casually said, “When you have your c-section…” instead of “if,” I knew I had to find someone else to deliver the baby. I was not having another c-section. It was 2010, and VBACs were still so much less common than just following precedent. I interviewed a number of midwives and eventually settled upon the midwives at Mt. Auburn Hospital in Cambridge, MA. What really sold me was when they said, “Western doctors go to medical school and read a thick book that has a small section in it devoted to what can go right. Midwives go to school and learn from thick book that is all about what can go right, with just a small part about what can go wrong. It shapes our perspective and keeps us focused on the positive, beautiful experience of child birth.” Perfect.
When I went into labor, I was fully prepared. Apart from wanting a successful VBAC, my birth plan, as it had been the first time, was flexible. This time, I decided that if my pain became intense, I would have an epidural. Simple. I wanted to be happy and strong to welcome my daughter. I felt good about knowing this. I went into labor a day after my due date, even though the contractions were still 10-12 minutes apart. They continued to get closer, but not close enough; about every 7-8 minutes for hours, then further apart, then close again. I went to bed, hopeful, only to wake up with the same status and same pattern. I went through the day this way, and by evening, I called my midwife as the familiarity of this situation hit me. Suddenly I feared a repeat of my four-day labor from my son’s birth.
My midwife advised me to have a glass of wine, then lie with my backside in the air, knees to chest, to slow my labor. This was around 7pm. I obliged, but by 11pm, the intensity of the contractions brought me back to memories of my previous labor. They were coming closer together, but somehow I knew I was not dilating. At 11pm, I called again, worried, knowing my contractions were only yielding pain.
I told her, panicked, that this was alarmingly like my previous labor. I begged her for any insight she could provide that might explain how a person could labor for so long and yield no result. I was heading into day three of unbelievable contractions, and I needed any kind of hope, wisdom and motivation she was willing to share with me.
It was at this point that I heard the term prodromal labor for the very first time. One definition I found describes it as: An early phase of labor that does not progress in a normal pattern: contractions do not increase in intensity and cervical dilatation is minimal. Yes, sort of. What my midwife said was that, for whatever reason—and often due to the fact that women spend more time sitting these days than they used to—the uterus tilts in a way that can put us into unproductive labor. She told me we needed to get my labor to stop so that my body could reset. How? Somehow I needed to get rest. At best, I should try and sleep. At worst, I could go to the hospital and they could give me narcotics to force me to sleep, which would stop the labor and allow it to come on when my body was truly ready. It seemed fine in theory, but I was waking up every 5-7 minutes in sheer pain. Sleeping wasn’t really happening.
At 1am, we headed to the hospital. There were no rooms available, so we waited until a nurse finally checked and told me I was 1 or 2 cm dilated. Each contraction hurt SOOOO much! I burrowed into my husband, and he did his best to soothe me. I knew I wasn’t supposed to wince or tense with the pain, that I should go with it and ride the wave, but I simply could not withstand the intensity. I wish, in retrospect, that I could say it had been doable, though to this day, I don’t know if I could have endured much more.
By 3am, I had an epidural, and I finally slept. When I awoke at 8am, my body had restarted, and I was in legitimate labor. My midwives came together to help me birth our sweet baby Penny, and she was born at 12:30pm. Everyone cheered for Penny, and for our group success with the VBAC. I felt hugely triumphant and SO very happy.
Looking back, there are a few things I know. If I had been made aware of what prodromal labor is, I am certain that I would have understood how to pace myself. I am a runner. I have run sprints, and I have run marathons, and it is all about the mind. You just have to know what distance lies ahead. Because none of the videos I had watched and none of the books—not to mention my birth classes or weekly OB appointments!—had mentioned this remote possibility, it was impossible for me to envision a positive, let alone finite, outcome. I thought I was defunct. I know now I was, and am, perfectly fine. My body was just doing what some bodies do. This was information that would have helped me so much.
If someone had simply said to me, “Danielle, this is prodromal labor. It feels real, but you need to zoom out and see the bigger picture. The pain will be really tough, but it will go away, during which time you will need to rest to gain strength for when it returns. It’s a pattern, but you can handle it, because it WILL end. It WILL result in labor, and you WILL be okay.” I needed someone to tell me that. Instead, I tensed up amidst a lack of knowledge and eventual worry.
I am still incredulous that no one ever brought up this possibility. How had my original OB never even known about this?! Had he known but just not thought of it? I don’t know. Frankly, it seems irresponsible to me. My doctor didn’t tell me about something that other women experience whose criteria applied to my situation, and that makes me uneasy. I am, above all else, grateful that my two babies reached their destination! I’m also grateful I can tell others that prodromal labor is not insurmountable, and that with the right support and awareness, giving birth will absolutely be as beautiful as you had hoped. Probably more.
Update as of 6/14/14 – a must-read post on cervical scar tissue, one cause of prodomal labor: http://thedoulaguide.blogspot.com/2012/12/cervical-scar-tissue-cause-of.html?m=1
Here are some links to other helpful information and stories about prodromal labor:
Here’s a great one:
Did you experience Prodomal Labor? Please share your words of wisdom with our readers.
DB Gottesman, a stay-at-home mother, Pilates instructor, and [dormant] artist with a formal marketing background, fills her days observing and relearning the world through the eyes of her wise and generous two-year-old and four-year-old. She is in the throes of parenting toddlers and wonders constantly what adventures lie ahead for her and her lovely, silly, sweet little family.