How much did you need to move in active labor?

[Blanca78]

Did you mostly feel like staying near the bed/birthing spot? Did you want to walk? Rock? Change positions much?

Just curious. I've been told movement is difficult for most women in active labor--and by that I primarily mean walking, not shifting positions or using a birth ball.

I ask because my doctor says she thinks continuous monitoring during active labor is a good idea. However, I'm a bit confused because the way she described active labor (contractions 2-3 minutes apart, lasting 60 seconds) matches the description here of transition? http://www.suite101.com/content/the-three-stages-of-labor-a19081

[donutmolly]

I think "active labor" is supposed to be from about 4cm to pushing (or whenever things get pretty intense to pushing)... but I could be wrong.

For me -- I definitely wanted to be able to change positions, but I wasn't going for a walk or anything by that point.  I've moved between shower/tub, bed, standing, squatting.  I think that was when I needed to move most.  Lots of rocking, swaying.  I can't imagine having to lay in bed or be hooked to a monitor at that point -- I really feel like that is torture to a laboring woman. 

My HB MW's monitored the baby by doppler every half-hour during active labor and every 5 min during pushing (of course, more often if baby doesn't sound great).  But they are the ones contorting themselves to fit my position, not vice-versa!

[Magali]

I needed to feel free to move during active labor.  I did a couple of contrax on my back while being monitored and it was awful.  I didn't need to be walking around, but being able to get on hands and knees or whatever was important to me.  Also I think there was a mental thing too, like I couldn't escape the contractions, but at least I could still move, if that makes any sense.

[XanaduMama]

Very, very important! Even if you can't actually move much during a contraction (in terms of walking), you need to be able to be upright, sway, rock, walk around in between, get in the tub, etc etc. Continuous monitoring doesn't necessarily preclude that, IF you can get the wireless kind of monitor, but it makes it much more difficult as they tend to lose the signal every time you move . IMO, there's no need for continuous monitoring in the absence of other risk factors. It sounds to me as though your OB is intervention-happy and will be pushing for pitocin, epidural and c/section pretty quickly if you don't "progress" on schedule. Any chance you could find another provider (ie, a midwife) more likely to support your desire for a natural birth? It's definitely not too late to change!

[lyterae]

I needed to be upright and swaying through active labor.

[tea_time]

I was also upright and/or bent over the bed.  I did not want to be laying in the bed until it was time to push.  I didn't want to walk around per say (didn't want to go in the shower, etc) but I did stand.  

Continuous monitoring could absolutely compromise your birthing experience, slow it down, make it more uncomfortable, etc.  

[gravida]

 I shifted around a lot in my labors. Not walking so much but moving from sitting, to kneeling, to on all fours, to standing etc. I did stay near the bed or tub but moved around to different positions a lot.

 Granted I spent my labor with my son in the water but I think I would have moved in a similar way on land. My heavy contractions I kneeled over the tub and wiggled my bum then went back to sitting for my rest. How I got back to sitting was different all the time. Sometimes I turned right, sometimes left, sometimes I stood first, sometimes I kinda backwards crawled. No way I could have had anything strapped to me. 

[Blanca78]

Originally Posted by XanaduMama 

Very, very important! Even if you can't actually move much during a contraction (in terms of walking), you need to be able to be upright, sway, rock, walk around in between, get in the tub, etc etc. Continuous monitoring doesn't necessarily preclude that, IF you can get the wireless kind of monitor, but it makes it much more difficult as they tend to lose the signal every time you move . IMO, there's no need for continuous monitoring in the absence of other risk factors. It sounds to me as though your OB is intervention-happy and will be pushing for pitocin, epidural and c/section pretty quickly if you don't "progress" on schedule. Any chance you could find another provider (ie, a midwife) more likely to support your desire for a natural birth? It's definitely not too late to change!

I know it does sound like they are intervention-happy. I'm not sure that's necessarily true--they told me they are fine with letting me go at least to 41 weeks, and the NSTs after that. Which isn't ideal (I'd rather 42 weeks) but there's no arbitrary induction deadline. And the practice's c-section rate is 10%; they were very forthcoming with that number.

At my 30 week appointment, my doctor actually encouraged me to seek midwife care because she said it was clear that was more in line with my desires--but the problem is both insurance and local options are very limiting. I can either drive an hour and a half each way for an in-hospital birth center, or sign up with a practice of CNMs who work with some OBs who are KNOWN to be more intervention-friendly than my practice, and there would be no guarantee that I would get one of the midwives for the birth. It's so frustrating.

The thing is, it was my OB's partner who told me the thing about continuous monitoring, when I remember my doctor saying way back that she only required continuous monitoring during the pushing stage. So I need to nail it down. My doula has worked with this practice before and said she's surprised that their practices seem to be getting more conservative, because she thought highly of them and hasn't experienced them requiring this stuff before.

I went into this thinking that with a clear birth plan and an experienced doula, I could have a good hospital birth. Now I'm worried.

[lamamaloca]

Once I was in very active labor, I did not want to walk around or even move more than gentle swaying. Mostly, I wanted perfect stillness so I could turn inward, but that's how I dealt with the pain. It may be different for you.

Continuous monitoring doesn't have to ruin your birthing experience. The way it is most likely to have an impact will be keeping you away from the birthing tub or shower. If you have made it clear that you want to be able to change positions and have a natural birth, your hospital is likely to assign you a nurse who can help you  do that even while being monitored. I had one continuously monitored labor, due to induction, but the nurse really helped me change positions, move around some, and worked with me even while being monitored, and I wasn't being monitored by telemetry. If your nurse cares more about the monitor than you, then you can have your husband/doula/other support person ask for a new nurse.

Does your doctor prefer continuous monitoring, or does she require it? Can you get an agreement on an intermittent schedule? I don't think you can assume she's a knife-happy physician just based on this, but it may be worth reconsidering your choice of care provider.

Transition is sometimes considered a subphase of "active labor," and in these cases "active labor" is used to refer to the time from about 4 cms, with strong regular contractions, until full dilation.

[Blanca78]

Thank you lamamamloca, this makes me feel better. I got the sense that it was more a matter of preference than absolute requirement, but because she was talking fast and the appointment was short, I couldn't really pin it down. She did say I could be unhooked to use the shower, etc., but thought I should be on the monitor if I were close to the bed anyway. It's also weird because this was the backup OB, and I clearly remember my doctor saying at 16 weeks or so that she only required continuous monitoring at pushing. So I need to get some clarification in writing. And the hospital doesn't have telemetry.

Originally Posted by lamamaloca 

Once I was in very active labor, I did not want to walk around or even move more than gentle swaying. Mostly, I wanted perfect stillness so I could turn inward, but that's how I dealt with the pain. It may be different for you.

Continuous monitoring doesn't have to ruin your birthing experience. The way it is most likely to have an impact will be keeping you away from the birthing tub or shower. If you have made it clear that you want to be able to change positions and have a natural birth, your hospital is likely to assign you a nurse who can help you  do that even while being monitored. I had one continuously monitored labor, due to induction, but the nurse really helped me change positions, move around some, and worked with me even while being monitored, and I wasn't being monitored by telemetry. If your nurse cares more about the monitor than you, then you can have your husband/doula/other support person ask for a new nurse.

Does your doctor prefer continuous monitoring, or does she require it? Can you get an agreement on an intermittent schedule? I don't think you can assume she's a knife-happy physician just based on this, but it may be worth reconsidering your choice of care provider.

Transition is sometimes considered a subphase of "active labor," and in these cases "active labor" is used to refer to the time from about 4 cms, with strong regular contractions, until full dilation.

[lamamaloca]

Originally Posted by Blanca78 

I went into this thinking that with a clear birth plan and an experienced doula, I could have a good hospital birth. Now I'm worried.

You can have a good hospital birth, it is possible. I've had two good experiences, even without a doula. I then had two out-of-hospital births (one at a birth center run by CNMs, one with a CPM) and am now going back to the hospital because it is what I am most comfortable with, as the birth center is too far from us for our comfort. I didn't care for my experience with the CPM at all. I don't like some of the routines in the hospital, but I like the peace of mind from knowing that if a serious complication does arise, help is right there. A hospital birth will NOT be exactly like a home birth or a birth center birth, but yes it can be a good experience none-the-less.

With your description of your options, I understand why you'd pick the practice that you've picked. I would try to clarify the monitoring issue with your own doctor, and get it nailed down in a birth plan. 

Just a tip -- going into a hospital with an overly detailed, rigid birth plan is not going to win you friends at the hospital. It can sometimes set up an adversarial relationship from the start, rather than a cooperative relationship. I've found that I have a better experience if I work with the hospital routines and the hospital staff rather than against them, and pick carefully which routines I need to request to have changed. Have you done a tour of the hospital or taken a hospital birthing class so you have an idea of what their routine practices are so you can know what needs to be an issue in your birth plan or not? It can help a lot if you are careful to word your birth plan in such a way that it elicits cooperation rather than seeming like a challenge.

[Blanca78]

Thank you again. It sounds like we're coming from similar places. I totally agree about the birth plan. I'm really trying to be flexible, but firm on the things I need to be firm with. I'm hoping I have some wriggle room with the monitoring, as I feel I've already conceded on the IV issue (although they made it clear there should be a way for me to shower with the IV. No heplock, as my doctor has recently had a couple of emergency situations where she could not get fast access because the heplocks hadn't been properly flushed by the nursing staff, but the IV can be capped off for showering).  Also, I really hope that with the guidance of my doula I can stay at home as long as humanly possible. We only live five minutes from the hospital, which is another reason I'm reluctant to change practices--and this OB practice gets glowing reviews from practically everyone I've talked to.

Originally Posted by lamamaloca 

Just a tip -- going into a hospital with an overly detailed, rigid birth plan is not going to win you friends at the hospital. It can sometimes set up an adversarial relationship from the start, rather than a cooperative relationship. I've found that I have a better experience if I work with the hospital routines and the hospital staff rather than against them, and pick carefully which routines I need to request to have changed. Have you done a tour of the hospital or taken a hospital birthing class so you have an idea of what their routine practices are so you can know what needs to be an issue in your birth plan or not? It can help a lot if you are careful to word your birth plan in such a way that it elicits cooperation rather than seeming like a challenge.

[msmiranda]

If it is just a preference on the doctor's part, it should be pretty easy to work out an agreement on intermittent monitoring.  My understanding also is that using the traditional EFM does not have to preclude standing, sitting on a birth ball or in a rocking chair, or being in some other position besides laying in bed.  (Assuming that you have a nurse who is willing to work with you).  As to your original question, once I was in active labor I did not walk around very much.  My preferred position was standing up leaning against something (bed, wall, dresser, whatever) sort of rocking or swaying during contractions, or kneeling and doing the same (but that got too hard on my knees after a while).  I'm not much of a water person, it just slows labor down for me, but certainly the EFM does preclude that.  I don't understand why the doctor would ask you to submit to continuous monitoring unless there was a medical indication for it -- around here anyway, it seems as though intermittent is seen as the standard of care for women who are not being induced and don't have epidurals, and I don't live in a particularly progressive place wrt birth. 

Definitely ask for some time to talk these issues out with your doctor.  Usually if you are polite and reasonable in your requests, most doctors will not have a problem accommodating you.  But at the same time, your plan to stay home as long as possible is a good one.  Particularly for a first-time mom, the longer you can stay home, the less likely they will be able to force you into their ridiculously restrictive labor timetable.