Episode 193 - What to do if your labour is fast
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD, and each episode I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey. Hello and welcome to today's episode of the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson, and I've been a midwife for 18 years. So I've seen all kinds of births, including the fast ones, and that's what we're talking about today. The really fast labor and births, the clinical or medical name for that is precipitous labor and birth. And believe it or not, this is one of the most requested topics that I've received of late. I didn't really understand why until I started doing a deep dive into what the internet is saying about fast labors. Now I can understand why you are all concerned about maybe it happening to you or maybe it happening again because the internet is full of outdated and old
[1:10] information about the consequences of a fast or precipitous labor and birth. So I'm here to set the record straight and share with you some new and hopefully some more helpful research including strategies to help you if you're preparing for another quick labor and birth for those of you who've had one before.
[1:29] So my experience with fast labors has been with my clients, but also for myself, my second birth, which I now realized as I was looking deeper into precipitous birth and revisiting this topic, my second birth would have been counted as a precipitous labor of birth, but I've never thought of it like that. I loved my second birth. I thought it was exquisite. I would repeat it any day of the week. But a lot of women are being told that a fast labor is somehow a malfunction
[2:02] in their body, that it's not normal and that it's a problem. So I'm finally going to talk about it today. I can talk about the causes of a fast labor, what it is, what is a precipitous birth, how to prepare for one and how to manage one if that is your experience, if you're expecting one again. But just before I do, I have something to tell you about if you're preparing for your birth, especially if you're getting prepared for a quick one. I'll fill this episode with strategies, but I also want to tell you two other things that I believe should be in your toolkit if you are getting ready for a fast and furious labor.
[2:41] Most women will experience their labor and birth as painful. And the pain of labor is different to the pain of illness or injury. But when you go into your birth, a lot of your care providers and the place where you go to birth, they may be pressuring you to receive pain medication in order to reduce or remove the pain. But the pain of labor is purposeful. It actually hormonally keeps your labor going. And so when you hear it like that, when you start to understand that the pain of labor has a purpose in the function of your body, in the efficient function of your body, we become more interested in working through the pain rather than getting rid of it. And as a home birth midwife, my clients know that they don't have the option of pain medication at home. So we have to come up with other effective ways of working through the pain of labor. So having the knowledge firstly that pain is purposeful in labor. That's the first thing. But there is a list of other things that are really effective and will be enough to make you feel like you don't need to get an epidural for your labor and birth if you don't want one. So I've been watching women use a collection of strategies over the last 18 years and I've used them myself of course.
[4:03] And so what I've done is I've collected up, gathered up all of these strategies and things that I've seen women use that have been effective in helping them manage the pain of labor.
[4:14] And I've bundled them all up into this guide. The guide has everything you will need to be prepared for the pain of labor and birth without the use of pain medication. It's called the guide to giving birth without pain medication. Look at that. It's everything I've learned over 18 years and it's all killer and no filler. I know many of you are busy. you don't have time for hours and hours of information.
[4:42] The link to the guide is below in the show notes. They're all little recorded video snippets, some for you and some for your partner and support people. Everything is covered in this guide to giving birth without medication. It's only $27, which is cheaper than lunch, but will certainly be far more valuable than a single lunch meal. Now the next thing I want to tell you about because this podcast is all about helping you get the best out of your pregnancy birth and postpartum and something that I love for helping women prepare for their birth is hypnobirthing and hypnobirthing is on point with what I'm going to talk to you about today.
[5:26] Fast labours can feel overwhelming and it feels like you can't catch your breath. Sometimes it feels like the contractions are one on top of the other on top of the other without that gap in between. But if you're prepared with some of the pain management tools in my guide to giving birth without pain medication and some hypnobirthing techniques, you will be so well prepared for what might come. These strategies are actually great for any labor but even more important for fast labors and the hypnobirth course that i recommend is the birth box by poppy child which also contains poppy's signature hypnobirthing tracks in the oxytocin bubble and i really wanted to mention this specifically today because the birth box has become a staple birth tool for thousands of women but what's more is Poppy has just added a new track into the birth box and into the oxytocin bubble which is all bundled together for you if you've already got the birth box it's in there for you if you're new to the birth box it's also there the track is called the anchor and it's designed specifically for fast and intense labor which is exactly what I'm talking about today the anchor is a powerful guided meditation and I always say that your ability to work through labor is more about mental preparedness than physical preparation.
[6:54] And the birth box and this new track, the anchor that's in the birth box is exactly what you need to get through an intense labor experience. And if you've been following me for a while, you know that I will only endorse things that I wholeheartedly believe in, but don't just take my word for it, The birth box has been given five stars across the board from women who have already used it to prepare for their births. And Poppy is giving Great Birth Rebellion listeners 25% off the birth box when you type the code word MELANIE in at the checkout. The link to get the birth box and the code word so you don't forget it is in the show notes. It's super easy to get just by scrolling down and clicking the link. You'll be glad you did. In fact, you can pause this podcast now, click the links below for the guide to giving birth without medication and the birth box, knowing that you will be fully prepared for whatever comes.
[7:56] All right, let's get into today's episode, which is all about fast and precipitous labor. And as I do with every episode, I already, when I'm preparing, I already have kind of a personal backlog of experiences as a clinician. So I start first by drawing upon that, and then I revisit some of the research that I already know and refresh myself. Then I go and explore the internet to discover what other people would discover if they search the internet for this topic this birth related information I'm just always keen to see what is what is being said in the outside world about each individual topic I know what things look like when I'm face to face and with women in birth I learned from that I learned from research but what's the messaging being told to women through the internet if they were to do a search? So I did the same for precipitous labor and I was shocked.
[8:56] Page after page after page just talked about the risks and the negative consequences of a quick labor. And if I was a woman reading it, it would make me terrified. But also I did not recognize the risks that they were supposing. I thought that has never been my experience of women having fast labours, that the list of risks did not seem accurate to me based on my experience, what I've seen, what I've learned.
[9:25] So I was really surprised to see that and I wondered where it came from. So a lot of the pages, they started off fairly innocently with just a definition of precipitous labour and birth and the definition was something to the effect of a very fast or rapid labor and birth, and labor is considered precipitous, it's considered abnormally fast, when it lasts less than three hours from the onset of regular contractions to the birth of the baby.
[9:56] And this was the point that I realized that my incredible ecstatic birth experience with my second baby would have been labeled as precipitous and then possibly as a pathological event. For my second birth, I had texted my sister at 8 p.m. To say, I think I might be in labor because I was getting some contractions, but I didn't know if they were going to continue on to actually to birth or into real proper labor. but I texted my sister at eight and I said, I think I might be in labor.
[10:28] By 10.30 PM, two and a half hours later, I was holding my newborn and I loved that birth. And actually only now that I have dived into this research am I even identifying it as a precipitous labor because I hadn't labeled it. I just gave birth really efficiently, like a queen but my experience was very positive and I never described it in medical terms I was shocked to see that my birth would have been described as a medicalized you know in a pathological way but I do acknowledge that a lot of women who fast have fast labors don't have that same blissful experience I wonder if because I was planning the baby at home and I did have the baby at home that there was no anxiety mixed up with oh my gosh am I actually going to be able to get to the hospital? Will I be doing this on my own? And we'll talk about that too. I'm going to give you a stack of tips about what to do if your baby comes before you get the help that you want. So I want to challenge the dialogue about a woman's body being somehow faulty if you laboured quickly.
[11:34] And a lot of the language around fast labours are about all the things that can go wrong and it pathologized it rather than celebrating the whole thing. Like, whoa, your body was so efficient. Some articles even described fast labor as something outside of a normal labor. I was flabbergasted. My labor was so low risk, so normal.
[11:57] So most of the pages that cited risks and negative consequences,
[12:01] though, were not internet pages that I would consider to be evidence-based, just so you know. But I am very curious to find out where they got their information. and as I looked into the research I discovered a few things that might explain it but thankfully the more recent research does not paint a picture of doom and gloom for women who are having short labours and here I will say again that some women are left feeling very shocked by their fast labours and I don't intend to minimise that experience.
[12:32] I will speak about how to reduce the overwhelmed for you about when labor is happening quickly. And certainly when you feel overwhelmed, there's more room for trauma and disappointment and fear inside the birth process as you reflect back. But I also do want to say straight up that if you labored really fast and your body was so efficient as to birth your baby quickly, this is not pathological. Your body didn't do anything wrong. In fact, your body is incredible and powerful and efficient and functioned perfectly and without delay. But it is true that if you're not mentally or practically prepared for a fast labor, it can feel overwhelming. And this episode will be helpful for you if that's what you're planning for another repeat fast labor. It certainly would take you by surprise, but sister, you did not fail. Your body functioned perfectly and efficiently and you can be so proud because your body worked like 10x faster than some other bodies.
[13:34] So now, if you were to believe some of the internet pages, you'll be told that fast labour puts you and your baby at an increased risk of complications. But I've looked into the research on that and I'll share the research that shows there are no worse outcomes for women or babies who experience fast labour. So I hope this episode will relieve any of those fears. But first, let's have a quick look at what might cause your labour to be very fast. so the under three hours. Firstly, your body is amazing and efficient at having babies and that is the most likely reason that you'll have a fast birth. The other one is maybe this is just how it normally happens for you and your family. There is a genetic element. If fast labors run in your family, you're more likely to have one as well. The next thing, the third one, is maybe your body has recognized that there is a problem and it needs to birth your baby quickly, which is also a testament to the power of your body. It recognized something's wrong. We have to get this baby out for its own well-being and your body worked efficiently and purposefully by having a fast labor.
[14:50] This can particularly happen for women who have high blood pressure or preeclampsia. It can also be substance-induced for women who are using substances during their pregnancy or on occasion as a result of placental abruption. All reasons that the baby needs to come out sooner rather than later and your body recognizes that. The other reason for a faster labor and birth is for babies who are preterm or growth restricted. These babies seem to have more of a chance of being born quickly. And I would assume that this is partly owing to the fact that they can be born through a cervix that's less than 10 centimeters dilated. You don't have to be fully dilated to push out a smaller baby because they will fit through a smaller, less opened cervix. But there also might be underlying reasons for why they're being born early and then that your body has decided it's time for them to be born. The other reason for a quick labor is maybe your induction is too forceful. So a fast labor can be a result of an induction medication, especially if it hyper-stimulates your uterus. This is actually a medical complication caused by a medical procedure, and it can't be attributed to a malfunction in your body. So if someone says, wow, you had a precipitous labor in birth.
[16:10] Somehow your body's faulty. No, this was a fault. in the medical procedure, and it's a side effect and a complication of the induction process. That's not on you. That's a complication of the medical procedure. The other people who, the other girls, women who are more likely to fast labours are teenagers. So actually, some of the research suggested that if you're under 20, that increases the chances that you're going to have a fast labour in birth.
[16:39] So there's some of the reasons and before I go into how to prepare for a fast labour, how to manage an actual fast labour and what to do if your baby is accidentally born at home, I'll address some of the research that I found about the outcomes of faster births. So if you are reading along, and this is your reminder that if you're reading along with the references for this episode, and if you're new to the podcast, I just want to let you know that if you go to melanethemidwife.com and sign up to the mailing list, you get access to this huge resource folder full of all of the research papers that I use to create every single podcast episode. This episode is no different. So if you want to have a read of those papers for your self or any papers for that matter that you are interested in from any episode, just sign up to the mailing list. You'll get a link to that big master resource folder.
[17:37] So this paper that I'm about to talk about is in the resource folder. So if you're reading along, this article is called Clinical Significance of Precipitous Labor, and it was written in 2014. And I will mention there There is actually surprisingly little written about fast labour, very few research papers that are written about this. But I found this study particularly helpful.
[18:03] So this was a group of clinicians who retrospectively, so they looked back on births that had happened and they examined precipitous births in their facility to identify the clinical significance and outcomes following precipitous labor for single babies, not twins or multiples, and they were head down. So head down, single babies, what are the outcomes? and they had two groups so they compared the fast labor group to the in inverted commas normal length of labor group so the authors commented you know in their preamble to the study that the prevailing opinion has been that rapid labor can result in maternal injury and place the baby at risk for trauma or asphyxia. So difficulties with breathing and deoxygenization. And they wanted to test if this opinion was true. Is it true that women and babies have poorer outcomes with a faster labor? So they wanted to answer that question. So the researchers, they also commented that there was, in fact, very little research, which is also what I discovered. And when I read theirs, I thought, oh, if you haven't missed something, there is actually not that much. There's very little research about the outcomes of fast labour. And again, that was in line with what I found. So this 2014 paper was aiming to address the knowledge gap.
[19:32] So they had a retrospective population-based study, and it compared singleton fast head down labors with normal labors of less than 30 hours. And this study was done in Japan, and the sample was taken from 2009 to 2013 within their facility. It was a maternity hospital in Japan. The authors also very helpfully noted that in their hospital, the routine practice for placental birth is that oxytocin has not been used in the routine for prevention of postpartum hemorrhage in the cases of precipitous labor. So in their hospital, they didn't routinely use oxytocin to manage placental birth, either normally or in precipitous labor and births. And one of the risks of a fast labor, what the outdated internet pages said, is that women are at a higher risk of postpartum hemorrhage. But what they were saying is they're not even using prophylactic oxytocin. So their research appears to be based off a more physiological approach to placental birth, which is exciting to me. Might not be exciting to anybody else, but I think that's exciting.
[20:46] So the number of women in this study was pretty good for the outcomes that they were looking for. So if you want to look at really rare outcomes, you need a bigger pool of study subjects of women, but if you're looking for more frequent events, you don't need as many women to be in the study. So during the study, there were 11,239 singleton births, and of those, 1,606 were precipitous. Now that represented 14.3% of all births that happened in their facility were considered precipitous, 14.3%.
[21:25] So that's the incidence. That's how frequently a precipitous birth happened in their facility. And then they looked at how common it was for women having their first baby versus their second or subsequent. So if you're having a subsequent baby, you had a 21.5% chance of having a precipitous birth. So by these stats, about one in five women who've had a baby before will have their next baby in less than three hours. So that certainly doesn't sound like pathology to me. It's just how labor usually works. Maybe our bodies just get better at it and more efficient at it. But if you're a first-time mom having your first baby, the incidence rate of a fast labor from this study was 6.6%. So overall, if you bundle women having their first or subsequent babies together, the overall rate was 14.3. but if you were a primate, having your first baby, it was only a 6.6% chance. If you'd had a baby before, 21.5% chance that you'll give birth in three hours or less.
[22:36] So then they looked at the outcomes, and it was none of the doom and gloom stories that you may have read about. None of them checked out. So what they found that with regards to first-time mums having fast births in their facilities, and as I said, they compared it to a group of women who did not have as fast a birth. So they had a higher chance of being under 20 years old.
[23:03] Also, babies under 37 weeks, more likely to be born quickly. And again, if you had high blood pressure, more likely to have a fast birth. That's what they also found. Interestingly, placental abruption, if you had a placental abruption in this study, less likely to have a fast labor. But let's look at some of the outcomes for the babies. So none of the babies in the fast labor group had an APGAR score of less than four at one minute. One of them had an APGAR score of less than seven at one minute. Compared to the other group, the longer labor group, the rates were not dissimilar. So what they showed is that there's no increased chance of your baby having, showing signs of distress or having a poor outcome immediately after birth as a result of a fast birth. That's what they determined. They also found that the women who had fast labors were less likely to have a postpartum hemorrhage of over a thousand mils. It was 7.3% in the fast labor group and 8.4% in the longer labor group.
[24:17] The other thing that people often bring up is that you are more likely to have severe peroneal tears. There's some kind of idea that if the baby comes out rapidly that our bodies can't possibly cope with that. They put that theory to rest as well. So severe peroneal laceration, which I assume included third and fourth degree tears and episiotomies, they were unchanged between the groups. 3.6% in the fast labour group and 3.7% in the normal length labour group. I'm not using normal length labour, but you know, the regular length labour groups, not the fast one. The only thing that did seem to increase was the risk of cervical tears, but when they commented on the findings, and if you're in research jargon, there are some percentage differences that would be clinically significant or statistically significant and others aren't. So while there was a statistical difference, a slight increase in the risk of your cervix having a little tear or a big tear with a fast labour, slightly increased compared to the slower labours and births, but it didn't reach clinical or statistical significance.
[25:35] So that's what they found in this one. And if you're having your second baby, the outcomes were similar. No increased risk of a bleed, no increased risk of severe perineal lacerations. In fact, there were zero severe perineal tears in the fast labor group if you had a baby before. The cervical tear rates reduced significantly. And in fact, you had more risk of a cervical tear in a longer labor as a multiple, if you've had babies before, than if you had a fast labor. And the outcomes for the babies, again, were equivalent. So that's the first study.
[26:17] And essentially, they didn't find any increased risk of having a fast labor
[26:23] of birth when they compared it to the other women. So we can put that to bed. And again, the numbers weren't too bad in terms of what they could compare.
[26:33] For what they were looking for. And the second one, again, if you're reading along, was a study called the impact of precipitous labor on the onset of transient tachypnea in vaginal births at term. And this was written in 2021. So transient tachypnea is where a baby is breathing rapidly after birth. And we sometimes consider this a sign of respiratory distress that maybe the baby's struggling to get enough oxygen in, and it can just be a sign that the baby needs help. So we always act upon tachypnea. But transient tachypnea is that it's happening, maybe it stops, maybe it starts again, maybe it went for a few hours and then it stopped. So they want to find out, are babies who are born fast more at risk of transient tachypnea? Are they potentially in a little bit of respiratory distress more so than if they were born slower? And this is one of the things that the internet pages said is that maybe your baby might be a bit shocked after birth and maybe it won't transition as efficiently as a result of being born fast. So let's see what they found. So the last study we talked about was in Japan. This one is in France. And this cohort included women who gave birth from 2013 to 2017. Again, it was facility specific. So they gave birth in a specific French hospital.
[28:02] And again, the inclusion criteria was that they had to have vaginal birth. The baby was born alive. So they only looked at the live babies and they were head down. And they compared women who had fast labors with those who had longer labors. Now, this study was almost twice the size of the Japanese study. They compared 2,644 women who had fast labours with an equal group of women who had longer labours. And...
[28:34] Actually, what they found was that there was lower transient tachypnea rates in the babies that were born fast, 1.6% in the fast birth group and 2.7% in the longer labor group. And so what they also did is they, there's a whole lot of fancy things that statisticians do and they adjust for certain risk factors to try and make the groups as equal as possible. And their comment was that the association between transient tachypnea and longer labor now, the association was no longer significant after they adjust for risk factors. So they concluded that precipitous labor, lasting less than three hours, is not associated with a higher risk of transient tachypnea in full term newborns after a vaginal birth. We can put that to rest your baby's not more likely to have respiratory issues if they're born fast all right now one more study and this one is from Saudi Arabia three different locations very helpful was also written in 2021 and it's called precipitate precipitous labor frequency risk factors and complication in patients delivering at Suleiman Ali Habib hospital sorry I don't like the words patience or delivering, but that's the title just so you can find it. Again, it's in the resource folder.
[30:04] So the aim of this study was to know the frequency of precipitous labour, so how often does it happen, the risk factors associated with it, and if it's related to complications, if it causes complications. So again, they looked back and they enrolled women who were in their facility between 2019, it was a six-month period between 2019, May and October. So they had 1,018 women in the study and 132 of them had a fast labor. So they calculated their frequency rate at 12.9. So you might remember I talked about the Japanese frequency rate was around 14.3% from memory. So theirs was equivalent to the Japanese study and represented that percentage of women will have a fast labor. They found, again, that if it had a family history of fast labours, that was a likely chance that that would happen again. And what they found, they said that postpartum hemorrhage was the most common complication observed for the women who had fast labour. However, the difference was not statistically significant. So slightly higher, but not statistically, when I assume clinically significant.
[31:23] So they found, as I said, the frequency was 12.9% and know that what their conclusion was, their final conclusion, no significant complication was observed in patients, women, having precipitate labour in their study. But let's have a look. So they had group A was the women who had fast labours and then they had group B, which was matched and there was 132 women in each.
[31:49] So postpartum hemorrhage, nine women in the fast labour group had a postpartum hemorrhage, eight in the other labour group. Pelvic trauma, which would be any tears, cervical tears included, was 1.5% in both groups. 0.75% gave birth on the way to hospital in the fast labor group and 0% in the other group. Shoulder dystocia was higher. There was only one shoulder dystocia of the 132 births in the normal length group. No shoulder dystocias in the fast labor group.
[32:24] Placental abruption was the same, 1.5%. So there was very few differences. One extra woman had a postpartum hemorrhage in the fast labour group compared to the in group B, which is why they said it was not a significant finding. Okay, that's the current research about outcomes. Fast labour does not appear, according to these research papers, as a pathological circumstance. It does not come with additional risk except that if you plan on giving birth in hospital, the only real risk that I can see is that you might not make it and you might be alone when you're giving birth. It's called born before arrival. So either the baby's born before you arrive to hospital or the baby's born before the midwife gets to you if you're planning a home birth. So born before arrival could be considered a potential complicating factor if you aren't prepared for it. If you give birth quickly because there's an underlying problem that could also cause a cascade of problems. For example if you gave birth to a baby after substance use and it was preterm and you didn't get to the hospital of course you might expect some issues with that baby as a result of prematurity and not having immediate care. That's kind of where I would see the main risk factors.
[33:45] So if you're preparing for a quick birth, maybe your family has a history of fast birth or your previous birth were fast. I'm going to tell you what you can do to be ready for a fast labor. And then I'll run you through how to manage it, how to manage your fast labor yourself, and what to do if your baby's born before you get to hospital or before your midwife gets to you. So I used to always have a talk, and I still do, I talk to my clients about what to do if their baby's born before I get to their birth. Sometimes the births are fast. Sometimes they call me too late because they're actually coping just fine. So I'm also going to give you my checklist of what I tell them what to do if your baby's born without me and the final thing that I will discuss too is if you actually need an induction.
[34:36] Because of a history of fast labor and I have heard this I've heard some clinicians recommend to women that if you've had a fast labor in the past maybe you should plan an induction, and we'll talk about why why do they say that all right so now we're going to talk about how to prepare for a fast labor. And by the way, you don't have to write all of these down if you're sitting there scribbling madly with your notepad, which is what I imagine you all doing as you listen to my podcast, which I know you're not. I know you're probably walking or waiting in the car while you're picking your children up from school or cooking dinner or your ear pods are in and you're doing something else entirely. But on the off chance that you're attentive and filling in your little notepad, you don't have to do that because if you access the resource folder for this episode. So just melanethemidwife.com. You can get on the mailing list for that. I've put a checklist in there for you to print off as you prepare for a fast labor. And there are some little spots to write down your plans and a little tick list to make sure that you've got everything ready. So here we go. Number one, assume your labor will be fast and prepare for it. And if it doesn't happen, you'll be over prepared. So number two.
[35:49] You will be laboring. So you'll actually be in strong, fast labor, which means you only have one thing to do, maybe two. Get dressed, that's the first thing. And then if you're going to hospital, get in the car and all you have to do is focus on your labor. You don't have a single other thing to do. And in fact, you will not be able to do a single other thing because you'll be putting all of your energy into managing labor and having a baby. So the rest is actually up to the people around you and here's where it can get a bit hairy because the people around you have to act fast and they have to be prepared and they have to be calm because you can't help them. You are busy laboring. So this section is just as much about preparing your partner and your support person as it is anything else because your job is done. You're in labor. You've got else to do so I suggest sending this episode to the people who are going to be with you for your labor and birth so that actually they are also prepared for your fast labor because they've got a vast more number of responsibilities to take care of you've got the one labor and birth because going to be rip roaring.
[37:02] They have to do everything else. So the third point is have a clear planned childcare plan if you have other children at home so that you can act quickly when you go into labor. So have the contacts stored in your partner's phone, not yours. We can put them in yours, but also put them in your partner's phone or put them on the fridge. Or if you're making a fast labor and birth plan and you'll see the plan in the resource list, put the numbers all there. The people that are going to come and look after your children or who's going to come and support you in labour and birth as well, because there might be a flurry and a flutter and you don't want to be stressing over the details of finding someone's phone number, who's going to come for the kids. So make all of these arrangements ahead of time about who will be coming to your house. Preferably they live close by and they will commit to having their phone on loud at night and they should keep it near to them at night so that they're easily contactable. And the main thing that happens with support people is that they're not prepared for the on-call life like some private midwives or on-call midwives are and you maybe won't be able to contact them at night. So make sure that they're really briefed on having their phone on loud, not on silent, that it's close by so that they can be up and ready when you need them. Potentially, they should have a bag packed so that they just have to get dressed and come to you.
[38:30] So I think have a few backups just in case you can't contact your main support person or have some of the contacts of the other people in the household or a landline so that you make sure you can get in contact with people fast. You don't want this delay of trying to call lots of different people while your labor's fast and you're trying to get to the hospital or you're trying to get your home set up for the birth. so in the later weeks of pregnancy make sure you always know where your car keys are, Have them in the same spot every time. Make sure the car's full of petrol, the baby seat is installed so that you can make a quick getaway and ensure that you have the hospital address written somewhere or saved into your GPS so that your partner can get there without thinking and without delay. This might be the first time you've ever driven to that hospital. That's not an unusual thing.
[39:24] So that's a way to be extra prepared. You're preparing for a quick getaway is basically what I'm trying to say. So also think about if your labor is going really fast, that your baby could be born on the way to the hospital. But if you think that your baby's really close to being born, I would actually suggest that you stay at home and phone an ambulance to come to you. It's a better scenario to accidentally give birth at home than to accidentally give birth in the car on the roadside. And call the ambulance to you if you think you're not going to make it. So also make sure you have the contact for the hospital easily available so you can call the birth unit, tell them that you're coming. Again, this will be the job of your partner, not your job. You've only got one job and that's to be in labour. The next thing to do with, this is the preparation time, this is all the work that you'll do ahead of your labor, have this ready before your 37 weeks, is to have some supplies in the car in case the baby is born. So you can put some puppy pads to protect your seats if your waters break or if the baby actually is born quickly. And also for towels, a few drink bottles of water and some baby wipes for a quick clean up for whoever catches the baby and to wipe down your car afterwards.
[40:45] Don't wipe the baby down with baby wipes. That's not what they're for. They're for the other people to clean up. All you'll need for the baby is a towel to keep the baby warm and also for the modesty of the mama. You also might want to put a few pillows in the car for comfort or for the drive so that you're comfortable while you're laboring and things are happening fast and you can get into lots of different positions. or if the baby is going to arrive in the car, a nice soft place to land. The next thing to do is have your hospital and postnatal bag packed and next to the door for a quick exit. Or if you're having a home birth, obviously still have everything ready right where you need it, including all your pain management tools and everything that you need. But the trick is to be ready. Every night after 37 weeks of pregnancy, set everything out that you'll need just in case you go into that labor that night and just in case it's fast. Some of you are expecting a fast labor. So be ready for it. You don't want to be running around looking for bits and pieces. Just pick up the bag into the car or you know that everything's there if you're having a home birth. Have the midwife's number available somewhere for your partner.
[41:56] The next thing you need to do is prepare your partner for a possible birth without any other care providers. And don't freak out because as we've learned, most quick births happen without anyone's input. Most births happen without anybody's input. It's all going to be just your own effort and your body's capabilities. You just have to have someone there to catch and pass you things and make phone calls. So now let's talk about what you'll be doing while the people around you are making calls and driving to the hospital, looking after kids, setting up the birth space, they're doing all kinds of things, whatever they're doing, all the other things. It might be a flurry and a flutter and you might be left for periods of time during your labor on your own. So you might being fully fledged labor and the people around you are a little distracted with the logistics.
[42:52] So I want to talk to you about how to manage the actual labor. So the things I just spoke about were the preparations, what can you do ahead of time. Now what's going to happen when you actually are in labor?
[43:04] So you probably won't have much time to ease into it. It may start quick and strong and fast right from the beginning. And the contractions will feel like they are one on top of the other with very little time to rest. Usually you would get a gap between the contractions for a few breaths and to soften your body. But in a fast or precipitous labor, you are definitely in a sprint race that you cannot stop. So you're not pacing this out. It's not a marathon.
[43:35] It's a sprint. And I remember for my own labor, I would have a contraction. It would ease off. I would sit back in the pool ready for my rest. And just as my back was hitting the back of the pool, I went, oh, here we go. Here's another one. They're just one after the other after the other with very little rest. It's physically intense, but more so physically you can do it. You're very capable, but it can actually feel emotionally overwhelming when you realize, I don't think I'm going to get a break. So the preparation that you're going to do ahead of time is around how to manage the pain and how to keep yourself from feeling overwhelmed. And so it's this overwhelmed feeling that sometimes sticks in women's minds when they have fast labors and it can last and they can hold on to it so personally although mine was intense it was not overwhelming because I will firstly I was planning a home birth so I knew that I didn't have to go anywhere everything was ready and my husband knew what to do so everything was set up I had my mum there to care for my other child I knew my midwives were on the way and all I had to do was labour.
[44:52] And I knew everything else was organized and everybody around me was capable. So it wasn't overwhelming for me, but I understand that it can be for some women, especially if everyone around them is freaking out. So we can't do much to change the physicality of it. You can apply some of the pain management tools that are in the Guide to Giving Birth Without Pain Management, the strategies that are in there. But things like heat packs and tens machines with these fast labors they just are not quite enough so the winning strategies that I think you will need for a fast labor and here's what I'm going to share with you now full list is that make sure you've prepared everyone around you to know that you'll be completely occupied you can't help them with a single other thing they just need to know that they're going to be responsible so your job is to labor and focus on that only and the winning strategies here for managing the overwhelm are positive self-talk.
[45:58] Your breath and your ability to use those two things to manage the overwhelm. And here's where I'm really going to recommend using the birth box by Poppy Child, which is what I mentioned in the early minutes of this episode and my guide to giving birth without medication because Poppy's birth box is full of hypnobirthing techniques and tracks and they help you to expertly manage overwhelm. They specifically are for overwhelming contractions and you can practice them ahead of time and then immediately activate them again during labor and if you listen to the tracks the soundtracks that are in the oxytocin bubble if you've got your headphones on and maybe the anchor track is what's needed if you've got your headphones on and that can help you focus and get into the hypnobirthing zone and manage through what can feel like an overwhelming.
[46:52] Circumstance but with your breath and with the tracks and with some of the the tricks and tips in the guide to give birth without medication the idea is not to reduce the number of contractions or even necessarily the pain it's to reduce your overwhelm so your capacity to cope increases so that you don't feel flustered and terrified because things are feeling big and strong. So the main thing about a fast labor is managing the pace and the lack of rest so that you'll need to breathe consciously and take full advantage of any of the gaps between contractions. Use the gaps or any moments of relief to concentrate on big, deep, slow breaths and.
[47:39] Softening and relaxing your body and talking to yourself so block out other stimulation because when you feel overwhelmed you can't have too much input people sounds lights anything else that is input will add to overwhelm so block out other stimulation you could use an eye mask which would block out visual stimulation and the earphones with the tracks running and this will stop you from any auditory distractions and also if you are well cared for and you know that the people around you are prepared you don't have to do any more of the mental work of keeping them calm and giving them instructions you can just focus on yourself now the final thing you'll need for a fast labor and this is what I talk about in the guides giving birth without pain relief is you have to speak to yourself positively. This is about mental grit and getting through with these affirmations and meditations. So instead of saying things like, oh, this is so big, or I'm not getting a break, or it hurts so much, or I can't do this, or it's too strong. Try saying things to yourself that are going to help you get through. So something like big, slow breaths. I'm going to just say big, slow breaths in your head. You can say it out loud if you want to.
[49:03] Use the rest to soften. Any rest that you get, any lull that your body goes soft. I'm okay.
[49:12] I can do this. So just keep repeating something in your mind that feels soothing and fills you with some hope. Even if you don't believe it, you will feel more capable just by saying them over and over again. Just put them in the place of, I can't do it. It's not going to help you. It's going to make it feel worse. You've just replaced those words with, I can keep going. Even if you don't believe it, even if you don't think you can, just say it. Something I did to fill myself with hope during my very fast labor which you know I really really liked but I remember thinking well I can't do it at this pace for too much longer and I remember looking at the clock and I said to everybody I'm going to be in my bed by 11 p.m because in my head I thought right this baby at this rate has to come out soon I can't I don't feel like I can go longer than 11 p.m. She was born at 10.30 and I was in my bed at 11 p.m. But I kind of mentally had to put a line in the sand, give myself hope. And I just said, keep telling myself the baby's going to be born soon because, you know, this is big. The baby will be born soon because this is a big, strong labor.
[50:29] So I'll remind you just in the show notes are the links to Poppy's Birth Box and the Guide to Giving Birth Without Pain Relief. You can get those down there. Super easy. Now, the other thing that is in the resource folder that you can print off, and this would be particularly for your partner, and it's something you can print off and put on the fridge or have somewhere easily. This is my what to do if your baby is accidentally born at home. You weren't planning on it. what to do if they're accidentally born at home or if you were planning home birth then this is what you can do if the baby comes before the midwife. So if you feel like your baby's coming firstly contact your midwife or an ambulance to come to you. Don't try and transport yourself. You're better to have the baby at home than in the car.
[51:19] Next, when you feel the urge to push, it's okay to go with it. There's no need to do anything extra, any extra hard pushes. You don't need to stop the pushing urge. Don't try and withhold from pushing. It's very unlikely you'll be able to hold your baby in long enough to get somewhere. Just breathe and go with the urges as they happen. It's okay to listen to your body. and if everyone around you could not say things like push push push that would also be helpful just listen to what your body's doing feel what your body's doing and go with it no need to add any extra just go with it now the easiest position to have a baby and to keep the baby as safe as possible is on your hands and knees it's the best way to visualize so I would suggest if your hands and knees on the floor over something soft like a mattress or some pillows so you could put some pillows under your knees and behind you just in case the baby drops so that it has somewhere soft to land particularly if you're there on your own.
[52:32] So I would also suggest if you've got time, choose a birth spot, a soft birth spot on the floor, on your hands and knees, somewhere downstairs, not upstairs if you can, so that it's easy for people to find you when they arrive. And if anybody's coming, like the midwife or the ambulance, they can easily get their equipment in and around if that's what they've got. Now, the people around you need to remember to unlatch the door, make sure it's not locked, and make sure that your house is easily accessible so that your midwife or an ambulance can come in without needing anyone's help and make sure all of your animals are locked away so they either don't run away or they don't get in the way of anyone who's come to help. I will never forget standing outside of this unit, this big block of unit and my clients were inside and the baby was coming out they could see the head but they just the number of doors required to get into the facility even to get close to the building there was all these intercoms and buzzers that needed to be pushed so they could unlock the door and I was stuck out there with my birth gear and I was calling them and they the partner just couldn't get away to um to let me in so he had to leave his wife to let me in with all the little buttons and codes. Anyway, if you can make it as easy as possible for somebody to get in without needing your help, that would be helpful.
[54:02] Now, the people around you and with you don't have to do anything specific after making the phone calls and unlatching the door and making sure the animals are away and the children are okay that are in your home.
[54:14] They don't have to do anything to help the baby come out. So yes, a safe place for the baby to land, grab some towels and some pillows, but they can keep their hands off the baby. They don't need to yell for you to push, don't need to touch the baby as it's coming out. They just need to keep you calm, tell you to breathe. Maybe they can give you some feedback about what they can see. If you think, oh my gosh, what's happening? And they say, well, I can see the head. Another thing for them to do is turn off all the fans and air conditioning. You want the baby to be warm without air blowing on them when they're born. Have a pile of towels ready.
[54:56] And the way that birth usually works is that either you'll push the baby's head out and then the rest of the baby will also come in that one contraction. Or, and this is completely normal as well, the head will be born. Then there'll be the usual gap between contractions it could be two or three minutes where the head is out but the body is still in, This is normal. It's important that once the head's born, the rest of the baby should be born in the next contraction if it wasn't born in that contraction. And so that's what you should try to do. If the baby's head's out, there's been a break in your next contraction, that's the time to push the rest of your baby out if your baby hasn't already come out in one go. And the people around you don't have to put their hands on the baby during the birth. They should not try and pull the baby out by any means. Don't put your hands on the baby. Let the baby come out. All they need to do is catch so the baby doesn't land heavy on something. And whoever catches, if it's you or your partner, don't move the baby far from you. The cord is still attached. So it's important that that stays intact and doesn't accidentally snap. So keep the baby close to your body or if you're catching, close to the woman's body.
[56:22] If per chance you did get super excited and you kind of caught the baby and then brought it close to you or too far away from the mother and it does snap, you've got to hold on to the baby's end and tie it off with a piece of string or something, cotton, wool, whatever you can find that is vaguely clean. Okay. And so if you're on your hands and knees, whoever is catching, or if you can catch the baby yourself, you should just pass the baby through the woman's legs. So when the baby's born, don't bring the baby upward towards the mother's back or even around her leg. Just baby out and in between the woman's legs immediately because you don't want to get her tangled up in the cord. So the baby's going hands and knees down and under towards the woman's belly and immediately place the baby's skin to skin, paying attention not to put too much tension on the cord, leave the cord attached. The safest place for a baby is skin to skin with its mother with the cord attached and a nice warm towel over the baby to keep it from getting cold.
[57:35] Then you want to get the mum comfortable with pillows Keep the baby skin to skin. Make sure they're both comfortable and warm. The next thing is don't pull the cord for the placenta. It may come away in its own. And if you're getting contractions still after your baby is born, that means your body is trying to give birth to your placenta. And I have a whole explanation of how to give birth to your placenta in another podcast episode on The Great Birth Rebellion. So I'll link that in the show notes below. So if you need to know how do I give birth to my placenta physiologically, then there's some tips in that episode, which is linked below.
[58:16] So those are the basics and they will help you while you're waiting for help to be on its way. Now, the last thing I will say that if your baby is born not crying and feels floppy in your hands, in your arms, put the baby skin to skin and rub the baby vigorously with a towel and blow air on its face with your mouth just. And this will usually be enough to make the baby give a big and vigorous cry. Very few babies will need resuscitation after a straightforward birth, sometimes just a bit of a rub, and remember they're attached to their cord, and the cord is their lifeline. They're still getting oxygen through the cord while it's still full of blood.
[59:03] And if the ambulance arrives or if they happen to be there for the birth, don't let them cut the cord of the baby too soon. It's better that the baby stays attached and just don't interrupt that for now while the baby's transitioning. They might be interested in doing this. Just please ask them. Don't. So that's pretty much it for what to do if your baby's born before your midwife arrives or before you get to hospital. And consider if you have a history of fast births and you're very worried about if you're going to get to the hospital or not or maybe the hospital is a long way from you then consider that this could be a good reason to actually plan a home birth don't plan to give birth in hospital plan to stay at home for the purpose of overwhelm and just practically it's a lot more strategic to plan a home birth if you've got a history of fast births. I've had clients like this, they did not specifically want a hospital birth, but with a labor that is 30 to 40 minutes long historically.
[1:00:05] What chances do you have of getting to the hospital? This particular woman that I was thinking of had her sixth and seventh babies with me. The first five was super fast and she only just made it to the hospital. And just the practicalities of getting five children cared for while also trying to get to a hospital and they'd since moved so they were further from a hospital part of the reason she wanted a home birth she did want one but it was very it made a lot of practical sense for her because of how fast her labors were and then when I arrived to her births I remember her looking at me and going oh thank god Mel's here and then she literally pushed her baby out it was as if she was holding it but that could be a practical solution to the problem.
[1:00:52] It's not a problem. But if you feel like it's going to be a problem getting to the hospital because you have fast births, consider planning a home birth. Now, the final thing I want to address is do you need to plan an induction because of a fast labor? The reason some women will choose this is if they have a fear that their labor is going to be so fast because the time of the birth is unpredictable. Maybe they're concerned that if they go into labor and the labor happens quickly, They don't want to be giving birth at home in the car or risk the possibility of not arriving to the hospital in time. In that case, some clinicians will actually suggest, well, why don't we pick the birth date of the baby as best we can and induce you so that you are already at the hospital when you go into labor? If you know me well enough, you will know that I think this is a bad idea.
[1:01:45] When I compare it to the option of a fast labour and birth. I won't go too much else into it, but an induction is not a no-risk option. It's not even a low-risk option. To have an induction introduces new and fantastic risks into your birth that didn't previously exist. So it's up to you to compare the risk of potentially not getting to the hospital in time with the potential complications of an induction of labor. And in the show notes below, I've put two episodes that I've written about the unique risks of induction for you to help make that decision. What feels more risky to you? An induction that's not medically indicated or the potential of giving birth fast and maybe not making it to hospital. That's not a decision for me to make. I know what decision I would make, but I will leave you with that information If your clinician suggests that an induction of labor or you want an induction of labor as a response to the potential of having a fast labor next time, consider all the information, the risks of potentially going to labor spontaneously and giving birth before you get to hospital versus the risks of an induction of labor.
[1:03:03] That is today's episode. If you want the two checklists, how to prepare for a fast labour, so there's a checklist of all the things to get ready. Then I've also made a checklist for the people around you, what to do if your baby comes before the midwife or before you arrive to hospital. Those two things are in the resource list, which you can get if you're on the mailing list at melanethemidwife.com. And don't forget the two additional resources, The Birth Box and the Guide to Giving Birth Without Pain Relief. All the links are in the show notes for you to be completely prepared for a fast birth that's less overwhelming.
[1:03:43] That's been today's episode of the Great Birth Rebellion podcast, and I'll see you in the next episode. To get access to the resources for each podcast episode, join the mailing list at MelanieTheMidwife.com. And to support the work of this podcast, wear The Rebellion in the form of clothing and other merch at TheGreatBirthRebellion.com. Follow me, Mel, @MelanieTheMidwife on socials and the show @TheGreatBirthRebellion. All the details are in the show notes.
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