6 ways to assess progress in labour

Keep in mind every body and every birth is different 😁 If baby is not in a good position, this can alter the pattern and intensity of contractions, which in turn lots of these signs. Even when you guess right, birth is a dynamic process that has the potential to change in an instant. ❤

1. the sounds she makes and the things she says

In early labour, (up to about 3 or 4cm) most mums can talk through a contraction. Even if she must pause, when the contraction finishes she can pick up where she left off.

In active labour (from 4 or 6 cm onward) talking during contractions is difficult. (Don't make her!) If she has been to my classes, she will probably use the Basic Breath. (You can do this together.) Some sing! That's good, as too. She might groan or moan through a contraction. This is great: low sounds help keep the body open and release endorphins. Higher pitched noises are a sign she doesn't feel safe, (that needs fixing!) and are usually associated with lots of tension in the body. At this stage, even when the contraction tapers away, she will probably be more withdrawn and less inclined to talk.

In transition (8-10cm, ish) she's more likely to make noise, even if she's been quiet previously. Adrenalin is peaking, so her vocalisation will reflect that. She might swear, or yell, or cry. She will probably say "I can't do it!" Or "I'm going home!"

Pushing stage has begun, or will soon: "I need to poo!" - that's the baby's head pressing on a bundle of nerves, and that feels EXACTLY like an enormous poo.

"I need to push!" - If she feels that in her belly, that's the baby moving down. She might have a little bit of dilating to do. If she feels it in her bum, odds on she's moving into the second stage.

As the dilation phase comes to an end, and pushing begins, you might hear grunting. If this is happening at the peak of a contraction, it could be sign she has a little bit of dilating still to do. If it's happening throughout, chances are the second stage is beginning.

Question: What noises did you make in labour?

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2. legs!

As your labour progresses, blood is pulled from the extremities and redirected to where it's needed more: your womb, baby and placenta ❤

This can leave your feet feeling a little chilly. You might or might not notice this (pack some fluffy socks just in case!)

As you go deeper into labour, this will extend from your feet and ankles up your lower leg. This corresponds loosely with how dilated you are.

Beginning of labour: if your feet and ankles are cool to the touch, you're likely around 1-2cm.

Early active labour: if the lower half of your calves feels cool to touch, you're likely around 4-6cm.

Later active labour: If your leg feels cool all the way up to your knee, that's a positive sign you could well be 8-10cm.

It's not perfectly reliable, and it's not really something that is useable if you're labouring in water, but it can be useful sometimes. For example, if your partner is using massage to help comfort and relax you, they might well notice this at the same time.

How "cool" is that? 😁👍

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3. the "purple line"

To be blunt, a purple line appears beginning at your bumhole, and the further up the bumcrack this line extends, the more dilated you are.

It has a pretty good rate of accuracy, although not 100%. (If your baby is positioned "back to back", it might not be as reliable.)

This is a way of assessing progress that doesn't involve touching you or disturbing you at all. Lots of women naturally labour in a position where the purple line is easy to see. (Do not ask her to move just so you can see it.) The purple line is something a birth partner can see, too. Knowing what it means has a positive impact, helping him feel less in the dark and more confident and calm.

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4. behaviour

I'm limited on space, so I'm only describing signs that show things are progressing, and not how to support each phase (that's something for another day!)

If you're able to assess your own progress, this is usually a sign you're still in the earlier stages 😊 So this is more for your partner 👍

As labour progresses, the neocortex (that's the modern, rational, "human" brain) "disengages", allowing the more primitive brain to take over. This, plus intensifying contractions and some spectacular hormonal shifts, cause noticeable changes in behaviour that can be a good tell for labour progress.

These are all general patterns that are often seen in spontaneous labour where things are progressing normally and the birthing woman is undisturbed and well-supported. We all react differently (so it's better if you know her well!)

Most people don't notice the very first contractions. The mum to be might seem simultaneously lethargic and restless. When contractions become noticeable, she can probably talk through them initially and keep moving about as normal.

Then they become obvious. She can't just carry on with what she was doing; the contractions demand her attention. If she has been to my classes, she'll be all over the Basic Breath like white on rice. She might close her eyes and lean forward. She won't be interested in talking while having a contraction. The neocortex is packing its bags.

She withdraws further into herself, entering an altered mental state. She buries her head in her arms. She moves less, as her body conserves energy between contractions. She's not just withdrawn during waves, but also in between. Perhaps she resurfaces to work through a surge and then returns to her resting position. She doesn't want to converse at all.

Thanks to the neurological and hormonal shifts occurring, lots of us display primal behaviour, a loss of inhibitions. We might strip off, or vocalise.

Contractions might seem to peter out at the end of the first stage. This is known as "rest & be thankful" and it does just what it says on the tin. (Labour can stall due to fatigue, or not feeling sufficiently private and safe, which is different!)

To recap, as labour progressed, the mum-to-be has become more inwardly-focused. Talking less, moving less, blocking out the rest of the room.

At some point, it's going to look like she "wakes up". Suddenly lucid, eyes open, talking again, motivated to sit up or stand up, and move about. Do not be fooled! The neocortex checked out ages ago. What you are seeing here is an adrenaline surge. 👍

Adrenaline will make her alert to any predators and also alert to meet her baby. The hormone shift also changes the contractions from "opening" to "pushy". Adrenalin makes her peek her head over the proverbial parapet and do a final sweep: my baby is about to arrive. Is the area safe? This can manifest in wanting to get away from people, wanting to go to another room or another location ("I've had enough, I'm going home!") or change position. It makes her restless, which is great because that often means getting UP - giving baby a clean line of descent and lending gravity to each contraction. She might also raise her arms and hold onto something above her head (also very helpful! Fellas: brace yourself. Don't get pulled into the pool.)

This delightful marriage of primal brain and adrenaline makes for the super fun times that we in the know call "transition". 😏 It can manifest as panic. Very commonly, it's "I can't do it!". She might be crabby, weepy or vulnerable, seem to lose control or do a one-eighty on something on her birth plan that was previously really important to her. (If she is going to punch you, now is the time. Duck.)

All being well, there should be a glimpse of a baby's head soon. At this point, you will know with certainty that she is fully dilated. 👍

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5. the fundal gap

When you are lying down, you can place a hand just above your bump. At term, when you are lying on your back, the gap between the top of your bump and the bottom of your sternum is about 5 finger-breadths

As labour progresses, there is less space here. At first you'll be able to fit four fingers, then three, then two, then just one.

The nifty part is that this correlates with dilation.

This is because as vertical muscle fibres ripple upward, pulling the cervix out of the way, your fundus thickens. By the end of the first stage, it's a thick, strong pad of muscle to help power your baby down and out.

There is a pretty big downside to this one - it needs to be done while you are on your back. And at the peak of a contraction, no less. I cannot think of many things less comfortable! Most mums only remember things like this in the early stages, anyway, so if you're still "with it" enough to try it, I'll take a wild guess there is probably still a 3 or 4 finger-breadth gap there. Like anything else, though, this is a tool in the box. I could see it being handy if you chose an epidural - but please do change position afterwards if you can!👍

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6. timing contractions.

I saved the worst for last!

This is a perfect way to make you feel observed. This causes a rise of adrenalin ("nature's breaks") and a drop in oxytocin (the contraction causing hormone). To put it another way, a perfect way of slowing things down. It's quite a lot like "a watched pot doesn't boil".

Paradoxically, there's a tendency for birth support to fall into the trap of being more focused on the clock or the app than the labouring woman. This causes oxytocin to really plummet. That is not what we want!

Often, first-time mums are advised something like...

"Wait until contractions are 5 minutes apart and lasting a minute and doing that for at least an hour..."

(Second timers being advised somehing like 7:1:1)

Every birth is different. I know women who, if they followed this advice, would be trying to go to hospital far too late in the process, and others who would be going far too early.

It's handy info to have if you're about to call your MLU. What your contraction pattern is like is a useful clue for them, given that you're not in front of them to assess based on other signs. It's just one piece of the jigsaw, though, and a detailed minute by minute approach is probably unnecessary. Ideally your partner can time them unobtrusively for a short period, or just make a mental note of the general pattern.

For example, when contractions are erratic, and when they seem fizzle out when you move about or have a bath.... this is still early in the process.

When they become more sustained, when you or your partner notice an obvious pattern, labour is becoming more active.

Typically, in advanced labour they do usually get longer, stronger and closer together.

If you notice that they are very strong, but very erratic, this is sometimes a sign your baby is "back to back" (aka occiput posterior). This can mean labour unfolds a little differently. There are lots of things you can do to help your baby shift, which I'll cover in another post.

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