Here's the thing, no one can predict how long your labour is going to be. Yes, first time mothers are generally expected to labour longer but I've also seen the opposite and learnt never to simply assume anything. Our birth 'wishlist' often includes that the labour isn't too quick (that's a challenge in itself although a different one) or too long but how it's all going to unfold will only become clear on the day. Sometimes there are indicators such as a baby in a posterior lie which can mean a longer labour but again, that doesn't apply all the time. So what do we do when we find ourselves in a marathon birth? Let me start by saying this: long labours are physically and mentally extremely challenging, for both the labouring woman and everyone supporting her. But there are strategies and ways to get through them without losing yourself and the end goal in sight: a positive birth experience.
1. Realise you're in for a long run
One of the biggest challenges especially for first time parents I'd say is to realise that things are going to take longer than they initially anticipated. They work too hard in the beginning, use up too much energy and time contractions for 24 hours without seeing a significant change in the intensity and length of contractions. It is called the 'latent stage' of labour which is doing a lot of necessary work to your cervix (shortening, thinning out, coming forward) and for some women this can take a long time as in more than 24 hours. For some women it happens over a few days with regular contractions happening for a few hours across several evenings only to fizzle out again and then eventually progress into established labour. So the biggest key in managing this early stage of labour is to preserve your energy, rest as much as you can, lie down for as long as you can handle it, hydrate and eat well (!) and don't try to move things along by bouncing on a birth ball or being active in other ways. You don't know how long this is going to last for and being emotionally accepting and present with where you are at whilst protecting your energy is all you need to do.
2. Take things step by step
Managing tiredness and physical exhaustion is a key factor during long births. Everything becomes so much harder when you're tired including remaining emotionally positive. Know that your body can go for a lot longer than your mind especially when thoughts such as 'how long is this going to go on for' or 'I can't do this for another 8 hours' and so on are beginning to creep into your mind. A really helpful strategy is to remind yourself to stay in the moment, here and now, not to allow yourself to think ahead (because no one can give you an objective answer anyhow on how long things might still be) and to just focus on ONE contraction at a time, sometimes ONE hour at a time...that's all you need to focus on. Support and encouragement from your partner and/or doula is crucial in these moments of doubt.
3. Selfcare for partners
Watching and supporting a woman labour for more than 24 hours is hard work, physically and emotionally. Selfcare becomes essential to allow partners to stay trusting themselves and continue to give support so it's important they recognise when they're beginning to run low. Stepping out of the room for a walk, fresh air, a good coffee at the hospital cafe can be incredibly refreshing and often means bringing new energy back into the room. The same goes for using the opportunity for a short nap, even if just means closing the eyes and switching off for a while. Eating and drinking regularly goes without saying.
4. Make decisions at the right time
Every labour has some key moments. Crossroads where decisions need to be made that will greatly influence everything that comes after. Take your time in making these decisions, ask to be given all the options (have all your questions answered) don't rush, ask for time on your own to discuss the options and especially if your baby is doing well any decision that gives you more time will likely be helpful. At the same time recognise what you need to give yourself and your labour more time, for example if you are absolutely and utterly exhausted then an epidural may be a helpful choice if the other alternative is going into theatre.
5. Stay patient and trusting, some things take time
Long labours are entirely normal and sometimes just what your body needs to go through to birth your baby. It is totally possible to have a baby come out of your vagina after labouring for 2 days but it will likely only happen by remaining patient, emotionally supported, making some measured choices along the way, a bit of luck and of course a baby that is doing well throughout. Long labours are not a sign that your body 'isn't working' but it simply needs time. Do what you need to do to give yourself this time.
6. Recognise and celebrate when you have 'given enough'
And lastly, there comes a point in some long labours when you need to recognise that it is time to let go of the wish for a vaginal birth and choose to welcome your baby via a caesarean birth. The reasons and timing of this point will differ from woman to woman and birth to birth but when it does, recognise that YOU HAVE GIVEN ENOUGH. You have done your best, have given it your best shot and that is all you can ask of yourself. And then to focus on feeling joyful about meeting your baby very soon, hopefully aided by the caesarean birth preferences you also put together as part of your essential birth preparation. Postnatally women often find it easier to come to terms with a caesarean birth when they have had the opportunity to labour until they reached this point, knowing they exhausted every avenue, energy reserve and patience before CHOOSING a caesarean birth.
As a doula I've supported my fair share of long births and would say that it's always a combination of factors that influence how long labours play out in the end. One thing I can say for sure: Having a doula by your side will make a tremendous difference when you find yourself in a marathon birth - both for the woman, her partner and the birth experience as a whole. Talk to me if you'd like to find out more about my support!