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Prodromal Labor

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These are easy to read and understand and are beautifully presented.

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Subsections on this page:

About Prodromal Labor

"Cervical dilation and effacement are produced from vertical fibers in a relaxed woman.  Stress causes horizontal and vertical fibers to contract, creating non-productive first stage labor."  [Osborne-Sheets, C. Pre-and Perinatal Massage Therapy.  Body Therapy Associates, 1998.]

Diagnosis of Labor: a Prospective Study [8/11/05] - Medscape registration is free

YOU’RE NOT IN LABOUR by Gloria Lemay

Human myometrium during pregnancy contains and responds to V1 vasopressin receptors as well as oxytocin receptors.
Maggi M, Del Carlo P, Fantoni G, Giannini S, Torrisi C, Casparis D, Massi G, Serio M.
J Clin Endocrinol Metab. 1990 Apr;70(4):1142-54.

Our results clearly indicate the presence of heterogeneity of binding sites in human uterus. Blocking experiments were performed to evaluate the density of OT and V1 AVP receptors in individual uterine specimens.

I have found that there is a common thread of wanting the baby, but not knowing what labor will bring so labor is syncopated. I call this sitting on the fence. I hate to start practicing invasive interventions like AROM, but I will practice a "tough love" approach. I explain during prenatal visits that the labor must be accepted, faced, hopefully embraced. I will pay a visit to a woman in prodromal labor to assess the situation and if she's all balled up in bed and not ready to have the baby I talk with her about choosing labor or staying on the "fence". If the latter appears to be the choice then I explain that I have other stops to make, and to call if there is a change.

Funny thing is... leaving a mother in that state is like walking away from a 3 year old who doesn't want to leave the park. As soon as you are out of the safe zone the kid (read mother!) comes running. They don't want to be left! Seems a bit immature but women in labor are somewhat childlike, and there is a mother relationship with the midwife.

So I feel that I am on the border of intervention. I will use bowel stim, cottonroot bark, etc... if a woman really needs to have the baby. Sleeping the woman is another intervention, using herbs or other labor stopping tools and having them sleep. If labor is truly imminent then there is no stopping it, then these mothers know that there is nothing to do but get on the path and help the labor.

I just hate thinking that I am somehow taking a new direction of altering labor.

I share your sentiments! And I like your fence analogy. I also use either Mother's Cordial, Preparatory Tea (I make both) or the homeopathic Matrigin (by Naturopathic Formulations) the last 3 weeks of pregnancy. It's been found to decrease prodromal labor in studies and that is my experience too.

I totally agree. I think it slows a woman's ability to "go within' herself if we stay.  Its like the "entertainment factor".

One of the things I do with all my ladies when they call is, go out, check dilation and well being of babe.  Wait one hour during which I time contractions for occurrence and duration and also place my hand on belly to see if contractions are hard and how long they are really lasting.  We chat between contractions.  For one hour she pays real attention.  Then I do another VE and see if there was any progress.  Unless something has changed, I go home.  Every time I stay too long, it is not good.

The docs I work with use prostaglandin suppositories to ripen a cervix if the woman is not contracting. It's made up by our pharmacy. Prepadil doesn't work in my experience and although at one point we were required to use Prepadil because it has FDA approval, we have gone back to the homemade suppositories. 4mg. We are reluctant to use them in women who are already contracting because they CAN cause hyperstimulation and fetal distress and we don't want to add this to her own contractions. I have worked with a doc who was willing to give the prostin and stand by with a warmed saline douche to wash it out if we had trouble. NO thanks.

I also sometimes try nipple stim if the contractions are not very frequent. Again there is the risk of our interventions causing problems and it is easier to err on the side of watchful waiting -- but then I feel bad when she gets exhausted, etc.

You asked for articles on prelabor/prodromal labor etc. I'll send my hand out along. I personally HATE to attempt to stimulate pre- or prodromal labor; I figure it will kick into good labor when the uterus is good and ready and the mom just needs to keep fed and rested. I've had some labors which we successfully "kick started", but unless there's a good reason, I think they do better on their own. I often wonder how many women get pitocin augmentation at hospital, when they really weren't in true labor.

Two observations:

  1. women might dilate in pre-labor, but they seldom efface, and
  2. true labor tends to progress (maybe not evenly, but eventually), i.e. the contractions become stronger and longer over time.
If there's little "growth" in the strength and duration of contractions, then I'm suspicious of it being prelabor -- it will probably stop on its own

Actually what happens in the hospital re: staying or going is both the nurses and their providers, of which I am sure you know. In WA our nurses won't keep or won't want to keep someone if they are not in labor. It would be the provider that makes them stay and aggressively tries to induce labor. Also, the women beg to be induced, and get on with the birth. I tell them that the birth will usually go better if they go into labor themselves, but they get impatient. What women need are things to help them go into labor, but again, does that take away from the birth just happening, and when is Intervention intervention?

We encourage our moms to drink lots of water during their pregnancy, and you are right, they get very dehydrated very easily. I always tell them that with the approx 50% more fluid volume in their system, they need to constantly replace that. Also, the edema in the extremities is improved with lots of fluids. Also soaking in a warm/cool tub of water can improve the irritable uterus and the dependent edema. Any herbs that seem to help either of those conditions??

I would want to clarify between preterm labor and warm up or false labor. I use the terms a bit differently. Up to 36 weeks or so, any regular pattern of contractions should raise the suspicion of PTL (though thankfully, usually not). The true definition would be cervical change, not just contractions. After 36 weeks or so, the increased uterine irritability is actually a good sign, as I think it helps tone the uterus and prepare for labor. I haven't seen a big difference between women with warm up contractions and women without, when it comes to labor. I do see quite a link between contractions and anxiety, however.

Off hand I think Friedman has a chapter on Latent Phase of Labor, and also the book describing Active Management of Labor has an excellent chapter about how difficult it is to determine the difference. Since Friedman (yes, as in Friedman's curve) is the only one who has tried to define "Labor", his terminology is used for research and are fairly standard definitions. It is actually the same thing to me. Warm up... in-coordinate... ineffective... prodromal. Latent Phase is probably the most frustrating aspect of midwifery for me, and I try to promote sleep at night and activity during the day

You somewhat hit the nail on the head with Prodromal Labor. Most moms after a long night of it are exhausted, and probably are begging for intervention, when actually the best plan is sleep and rest. My theory is: sleep at night, active during the day, unless of course they have been up all night. We had a gal who had lots of prodromal labor, with subtle cervical change. We thought something was happening, so we tried nipple stim and walking, and she became more exhausted. Then we talked: the choices: home, AROM or pit. I recommended home. She wanted home, and went home. I suggested relaxation away from family, Benadryl 25 mg or Vistaril 100mg to help her once evening hit. I don't know whether or not she took the medications, but the next morning things had stopped, and she was a bit sad.

By Monday (over the weekend) she was happier, and later presented again with prodromal (head was wayyyy down in the pelvis...also a primip). This time she went with AROM with my partner, and had a longgg labor, but seemed happy with the outcome, because it was her choice to intervene.

What I am getting to is two things: 1 Being able to make an informed (not persuasive choice) is critical...some women want to be induced, even if presented with other options. 2. Women need to be encouraged to believe in themselves. We need to overcome the years we have told them their bodies don't work.

If you look closely at Friedman, and prodromal labor, you will see that he actually recommends sleeping (he suggests Morphine) in preference to pitocin and AROM. Those interventions only lead to problems...a tired mom and tired uterus. I have modified the 'chemical' intervention, and found Vistaril and even Benadryl work quite well especially if Benadryl makes the woman sleepy normally. I haven't seen any negative effects, and do see a rested mom the next day. What I tell moms is that if the baby looks good, and the mom looks good...there is no need to rush things. Most women accept this simple (and I feel logical explanation) that sleep is the most important commodity. Of course, this is after lots of showers and tub baths.

The thing about midwives, I think, is that we are so practical. We try to logic things out with nature in mind, without the need for a scientific explanation. It is usually there, the scientific explanation, or it hasn't been found yet. Through the recent years I have chuckled to myself, as I see the practical, common sense approach of midwifery be proven to be the better way to go in the long run. Now we are getting research to prove it!! Yes!!

A rather long answer, but you too give the choices, and then give the power back to the mom. That is empowerment, and that is what it is all about in my eyes.

This is an on-going problem. I do all the things you suggested in your post at various times. I also sometimes give morphine IM or IV and hope that she will sleep for a few hours and either wake up in active labor or wake up not in labor at all. I still end up occasionally with an exhausted woman who is not progressing. Frustrating. I can't help but think there are psychological issues involved. Is she not ready for labor --- for motherhood --??? How to approach this in a busy tertiary care center with women who may not speak English is another story!

I hate the term "false Labor",; it sounds like we're faking or just pretending to be in labor. But I've experienced "false labor" with my pregnancies, and I was certain I was "truly" in labor at the time. "False labor" feels just like the real thing, so don't feel badly if you get the midwives and all of your friends over to the house for a "no show". It's not your fault.!

Midwives call false labor "prelabor", because it's a more accurate term. Your uterus is contracting just like it will when you go into real labor; that's why it feels the same. But the contractions of prelabor aren't as firm, usually don't last as long, and eventually fadeout with no baby to show for losing a night's sleep. And can leave you feeling exhausted and irritable!

These are some ways to tell pre-labor from the labor that's going to last long enough to get you a baby:

Contractions of prelabor tend to be short--under 30 seconds, and are unlikely to get longer than that. (Maybe 45 seconds). If they are longer, or become longer with time, then they are lighter and LESS firm. Time your contractions.

Pre-labor contractions don't progress like true labor contractions do. They may start out 5 minutes apart and 25 to 35 seconds long, and an hour later they may still be at that same pattern. USUALLY true labor contractions progress. They may be irregular and have a lot of variation, but you can usually say that the contractions are longer/stronger now than they were an hour ago. Compare how you feel now with how you felt earlier.

You may still experience a show with pre-labor. It will usually be blood streaked mucus and may not be a complete "plug". If this happens after a vaginal exam it was probably just dislodged early. Your plug will reform.

If contractions are keeping you awake at night, take a warm bath, drink something soothing, eat lightly, then try to go back to sleep. You won't stop real labor by going back to bed, and it doesn't do you any good to be up all night with no reason. Your baby will be keeping you awake soon enough!

True labor may be accompanied by nausea and diarrhea (of course so may pre-labor). Or you may have a labor with none of these other signs. Keep in close touch with your midwife, she can help you decide when labor has begun in earnest. Don't hesitate to call. Any midwife will GLADLY sit out 10 pre-labors with you, rather than miss the real event!

"If you try to stimulate before the cervix is fully effaced you can be pushing a cart up hill! 'Don't push the river, it flows by itself". In a long prodromal, go with the contraction pattern: nudge it along when the contractions are strong and rest the mom when they fade. Prolonged prodromal is not associated with any other labor abnormalities so long as baby and mom remain strong, nourished, and hydrated. I wouldn't admit to the labor ward in uncomplicated prodromal except for the therapeutic rest. Active labor is often fast when it comes."

What sorts of things do you do for irritable uteri, how/when do you decide  when it's best to use therapeutic rest (and what ways do you do it).

For me the cut off is when the woman says "bothersome contractions" that are "just there."  Or the woman who comes in for a labor check, she is visibly hurting, bags under her eyes, looks like s**t, isn't eating or drinking and is consequently dehydrated.  And her family doesn't look much better. Therapeutic sleep treats the family also.  Depends on many factors.  A lot has to do with whether she called first. Sometimes, I feel that if they are calling first, instead of just coming into the hospital, they are just asking for helpful suggestions to allow them to stay home.  When they come in, with no forewarning, they have decided that "this is it."    How much make-up is mom wearing?  Did she take the time to shower and put on her pearls before she came in?  Add a dab of perfume?  Is she still looking "too cute."  How many people came in with her?  How many days since she's had a good nights sleep?    For the bothersome stuff --Rx with a hot shower and alcohol.  (wine, beer, etc.)  It's early in the game, but she could use a little rest to get her over the hump--Vistaril 100mg IM and send her home to turn off the clock, phone, door bell, and get rid of the family except for SO.  All the usual instructions about sleep, fluids, food, walking, showering, tubbing, etc., etc., etc.  She's looking bad and family is growing fangs--IV hydration (1 liter bolus then maintenance), Morphine 5-7mg IVP with 100mg of Vistaril IM, (because of the narcs she has to be admitted in our facility), sometimes will also give a SQ dose of Morphine in addition to the IVP.  Get rid of all the family, including the SO.  More than anything he needs to sleep and no one except anesthesiologists get good sleep in the hospital.  Lots of reassurance that we will call when she wakes up.  Most families, by this time, are ready to get some rest themselves.  I am totally against starting an induction at this point in time.  This lady needs to sleep before we toss her into the fire. Neither she, nor her SO will have any reserves for labor if we start her up now.  After she wakes we can discuss induction or going home.  Sometimes its not an issue because they wake up 6-7 cms and ready to go.  There is no magic remedy.  And sometimes we choose or suggest strongly the wrong option.  You don't know what the effect will be until you try it.

My recipe for irritable uteri and/or prodromal labor is a glass of wine or so and warm soaks.   I had a long prodromal for my last one. Unfortunately I was neither a midwife or under midwifery care. I walked and rested with q10 min 40 second ctx from Monday morning until Wednesday morning. Wish I knew enough to have a few drinks back then.   Reminds me of  the primip who decided to drink a whole bottle of wine instead of the 3 oz I gave her in a take home cup. She had been doing the prodromal thing for 36 hours and the last time I checked her at 10pm she was -2, 2 cm with q5-7 minute ctx. Babe was also obviously op. I sent her home with the wine and instructions for warm baths. She called at 2:30 am wanting to push and when she came to the center 15 minutes later was complete and OA.  20 minute 2nd stage, but baby was drunk as a skunk.  That's when she admitted to the bottle of champagne.  Be sure to warn them not to drink too much......not for FAS, just so that the baby  will be alert after birth.

LOL (sort of)... what do you do for a drunk baby?  I know coffee is  out.

You let him sleep it off, worry a lot, and keep checking his neuro status and reflexes to reassure yourself.

Our two favorite sleepers are: Benadryl 50 mg or Vistaril 100mg, po. The Benadryl works well for restlessness in the weeks before true labor. Vistaril works well for the Prolonged Latent Phase, and one can take it at home, at bedtime.  Women with lots of CX, thinking they are in labor, probably need to be delivered, as they think they are in labor, and will remember it as: being in labor for days!!  If they refuse, well, that’s okay too. But its a good argument for getting them going in labor, if the contractions persist.  I agree relaxation is the key !!

 How many days since she's had a good nights sleep?

A previous back-up advises a night or two of unisom. Anybody have any words of wisdom on that one ?

The body metabolizes 1 oz of alcohol in an hour.  You don't want to recommend more alcohol than they can metabolize before the birth occurs.  Yes, a drunk baby does have more trouble adapting to extrauterine life, just as a drugged baby does.

I think a good night's sleep is key. I use po vistaril or Tylenol pm. Never thought about Unisom (there are 2 kinds...one is the antihistamine used in Bendectin, one is the same as benadryl, I believe).  The worst thing is a woman going into labor when she has been up a night or two in very early labor.

Tylenol PM, plan Benadryl, valerian and passion flower are my remedies.

Here's my recipe for prodromal labor:

1) Eat a banana and drink a glass of milk (for the tryptophan -- a turkey sandwich would work, too)
2) Take a warm bath
3) A glass of wine or beer (I indicate the size of the glass, specify a small amount only)
4) If alcohol is contraindicated by religious beliefs or substance abuse history, I recommend substitution of Sleepytime or other chamomile-based tea for the wine.

I explain the rationale for all of these, the tryptophan, the relaxation, the uterine relaxation.  I suggest strongly that this will help her sleep (placebo effect).  I stress the importance of doing these steps in exactly this order.  Works well for me.

There are some labor patterns that are caused by adrenaline, which accompanies physical activity, excitement or anxiety: 2- 3 minutes apart but short (20-50 seconds), or alternating short (20-50 seconds) and long (up to 4 minutes) contractions.  High adrenaline can cause a lot of vomiting, diarrhea, anxiety shaking, and an elevated pulse.  Put on some really relaxing music or a guided imagery audiotape, darken the room, maybe light some candles, use aromatherapy, take some Centered Mama or alcohol of your choice (Jagermeister, port, wine or vodka are the traditional recommendations), and take a warm bath in a relaxing position (i.e. not on hands and knees in the birth tub).  These contractions are typically non-productive and just wear you out; you must do something to relax deeply so you can rest before active labor starts.

Outline on Prodromal Labor

  1. Overview of prodromal labor:
    1. Medical observation of this condition is commonly labeled false, early and latent labor. Respectively referred to as dysfunctional labor.
    2. Can occur intermittently over period of hours or days.
    3. If a woman presents with this condition she may be sent home with no instructions on care, and told to call or come back when she's really in labor. Or she is admitted, with expectations to deliver within a defined time period (usually 12 hours).
    4. The woman may feel embarrassed, and unsure if she'll know when real labor starts. In a home care or birthing center she's told that this may be labor and may be encouraged to walk and facilitate the process. Support and acknowledgment are important to the pregnant woman.
  2. What can be done to assist a woman with this type of labor.
    1. Education about the changes in the late part of the third trimester should include information on prodromal labor.
    2. Suggestions to drink water, rest, change positions, or if already idle, to become active by walking then monitor any changes. Suggest remaining calm, getting sleep if late, eating light, even if it's early labor there is no benefit getting too involved, conserve energy for active labor.
  3. Describe the dilemma of non intervention versus intervention.
    1. By allowing nature to take its course a woman could have prodromal labor for days. This could disrupt sleep and consume energy that will be needed when labor is more demanding. If a woman is tired and not progressing she may be given Pitocin and other interventions, increasing the risk of cesarean.
    2. A hands off approach could culminate in a short prodromal labor that stops with no ill effects, or progresses on to a productive labor.
    3. Interventions such as walking, increased fluids, nipple stim, bowel stim, and the like can stimulate labor to a pace that would indicate that labor has begun. Most of these approaches are fairly safe and may or may not induce a labor. If they do work may be considered interventions.
  4. Cover common medical procedures encountered by a woman hospitalized with "false" labor.
    1. EFM
    2. confinement due to EFM
    3. Pitocin
    4. Narcotic analgesic agents.
Teaching Plan:

Divide in to buzz groups and ask what they would do with a woman who's had 2 days of prodromal labor. (Use 4. Active Management of Labor - the Dublin Experience 3rd Edition 1993 K. O'Driscoll, D. Meagher, P. Boylan 5. Midwifery Management if Prodromal Labor - Journal of Nurse Midwifery * Vol. 30 #6, November December 1985) to lead the example)

This should lead in to a discussion about the psychological aspects of childbirth. There is a large gap in education in dealing with the emotional and psychological element of birth. Fear of unknown, fear of repeat bad experience (VBAC) , pressure to have a certain kind of birth (Natural), and sexual history can inhibit acceptance of labor.

My personal approach is one of education, and of emotional support. Education can prepare a woman to "hear" that she needs to make a choice. She can try to stop the labor, leave it alone, or help it along.

In a nutshell when does interceding become intervention?

Definitions (handout)

Commentary on prodromal definition "approach of disease"!

Ask what from their experiences with this type of labor would be a desirable outcome.

Would it be to stop it? If so reasons may be to conserve energy, or avoid premature birth.

To simply monitor and allow natural outcome? A non intervention oriented approach or wait and see?

Try and affect it.

Lecture Notes for ICEA Session on Prodromal Labor

The most important single item in the overall conduct of labor is diagnosis. When the initial diagnoses is wrong, all subsequent management is likely to be wrong too.

Source "Active Management of Labor - The Dublin Experience 3rd edition 1993 -O'Driscoll, D. Meagher, with P. Boylan.

There are few maternity centers where any serious attention is devoted to the diagnoses of labor. The general assumption is that no such problem exists, because women are naturally endowed with the instinct that enables them to make a correct decision in these matters. The subject is not discussed at any length in textbooks and is evaded in medical publications, where only cases said to be in labor were made retrospectively .

The record will doubtless show that Caesarean section was performed for maternal or fetal distress caused by prolonged labor, whereas the truth of the matter is that the initial diagnosis of labor was incorrect: a state of labor never existed.

Alternatively. a woman's diagnosis of labor may be rejected by the staff, in which case she is transferred to the antenatal ward, perhaps to return a short time later well advanced in labor.

Approximately 10% of women under the impression that they are in labor are mistaken. It is a matter of utmost importance that these individuals be identified before they find themselves on a production line from which there is but one escape route: medical interventions up to and including Caesarean section followed by great anguish.

Interesting to contemplate the theory that a woman in false labor can have adverse effects all other women in labor. For example a high rate of induction has an important indirect bearing on others -because the limited resources of a delivery unit - especially human resources - are dissipated in caring for women who are not in labor.

Labor: Clinical evaluation and Management, 2nd edition 1978 - Friedman Emanuel A. This book states the following: If the contractions should continue beyond the prescribed limits of the normal latent phase (different for primipara than multipara) and not result in cervical dilatation, it's justified to diagnose abnormality of the prolonged latent phase. False labor is usually diagnosed retrospectively in about 10 percent of women with a prolonged latent phase - the wisdom is gained in hindsight when the contractions finally stop! It's clear that making a correct diagnosis is of great importance when applying interventions. If augmentation is chosen and fails to improve the progress then the process may be stopped before passing the "point of no return". A woman who had been augmented is often retained for 12 hours to ensure that she does not assume labor retrospectively.

He goes on to recommend rest versus augmentation "The therapeutic measure we utilize for providing much needed rest for these patients-namely, large doses of narcotic analgesic agents-will usually provide us with an answer in due course. Those in false labor should not resume their contractions when they awaken from this regimen. The therapeutic trial thus aids us in making a meaningful differentiation.

Differential diagnoses and Evaluation. An obviously unripe cervix-that is, one that is long, closed, tough, and rigid-is not likely to be encountered in a patient who is in early labor. Since false labor and true dysfunction cannot be distinguished prospectively under these conditions in any manner that even approaches objectivity, the patient should be given the opportunity to show her ability to respond to sedation and the rest that it offers her.

Labor: Clinical evaluation and Management, 2nd edition 1978 - Friedman Emanuel A. The transition from false or prodromal labor to the latent phase of true labor, especially where it is smooth and uninterrupted in time, is seldom well defined. It may be noted when the mother suddenly takes notice of the pattern intensifying. From the foot of the bed, so to speak, the early part of the active phase is entirely indistinguishable from the latent phase. Neither the patients subjective appreciation of contractions nor the objective evaluation of the contractibility pattern by the tocodynamometer or internal strain gauge aid in this regard. Thus charting the dilation-time curve is essential.

Fetal Position The frequencies of fetal positions were of interest by virtue of the high incidence of both transverse and posterior occiput mechanisms in labor. Together these comprised 78.6 percent of the study population, as compared with 47.4 percent among normal subjects.

Delivery As to delivery frequencies, there was an increased incidence of cesarean sections (23.7 percent overall versus 4.6 percent for normal nulliparous population). Among those in whom the labor process was allowed to evolve, the cesarean rate was 10.6 percent. Abdominal deliveries were concentrated almost exclusively among those subjected to cesarean section without adequate further trial of labor (62.3 percent of the sections that were done) and among those who later developed an arrest pattern of labor (34. percent). There were no abdominal deliveries among those nulliparas with prolonged latent phase whose labors were allowed to proceed normally. This was a critical observation.

From Friedman's data "is does not appear that latent phase prolongation of itself adds significantly to perinatal mortality.

Etiologic Factors We now recognize that the latent phase is remarkably sensitive to narcotic-analgesic-sedative medications administered to the gravida. The incidence of over sedation among women with normal labor patterns on our population was 8.6 percent; among those with prolonged latent phase it was found to total 38.7 percent. After the effects of the medication had abated, subsequent labor patterns were essentially normal in almost every one of these individuals.

Comparison of Treatments Oxytocin infusion, therapeutic rest and amniotomy. Oxytocin infusion was administered IV solution of 10 IU in 1000 ml of 5% dextrose, with increased dosage every 20 minutes until effective contractions were produced. Therapeutic rest consisted of the administration of morphine sulphate initial dose of 15mg subcutaneously or 20mg for a large patient. If contractions were still appreciated by palpation after 20 minutes another 10mg (15mg for obese gravida) would be given.

83.9 percent of the patients who were rested terminated the latent phase within 10 hours after the therapy initiated. Noted: Excessive medication can prolong the latent phase a paradox is accepted.

Among patients with AROM used in the latent phase to stimulate labor, only 26.9 percent evolved promptly into the active phase. This figure is actually high, many amniotomies were done during the acceleration phase, however we included these cases as it was difficult to distinguish from those in which it was coincidence. Since only this small number progressed into the active phase within the arbitrary 3 hour time limit, we considered that AROM was of dubious value in the treatment of the abnormally long latent phase.

The results with aggressive therapeutic rest were impressive. Patients who were given large doses of narcotic analgesics for purposes of inhibiting uterine activity entered the active phase most often between 6 and 10 hours later. This is shown by a peak distribution curve for successful termination of the latent phase among those women who were sedated and responded (nearly 85 percent). While it is clear that oxytocin and rest are equally effective, the distribution curves do not reflect the phenomenon precisely because the curve for rest has a wider spread over the course of time.

A Guide to Effective Care in Pregnancy and Childbirth states. "The assumption underlying is that "inadequate" progress in bad in some way and that 'something should be done about it'. In the past proposed remedies included homeopathics, spasmolytic drugs, relaxin, intracervical injections of hyaluronidase, and vibration of the cervix. Currently common measures include amniotomy and intravenous oxytocin infusion. There should be a substantiated reason to use amniotomy and intravenous oxytocin infusion other than prodromal contractions.

Brief note on intravenous oxytocin infusion:

Intravenous oxytocin infusion. Of the three trials that provide data on the length of labor when intravenous oxytocin infusion was used in cases of poor progress, only one showed a shorter mean duration in woman allocated to early oxytocin augmentation n compared with the controls. In one trial women in the control group were encouraged to get up and move around, stand, or sit as they wished, the mean duration of labor was shorter then in the augmented group. However over 80 percent felt that augmentation increased the amount of pain they had, whereas less than 20 per cent felt that walking about had increased their pain. From the data available thus far, it does not appear that liberal use of oxytocin in labor is of benefit to the women and babies so treated.

Now, don't shoot me.. but I carry a small bottle of alcohol (whisky or rum) in my birth bag for moms in this situation -- needing something desperately to "get them over the hump". A good shot in a cup of warm sweat tea -- or in a glass of cold soda, seems to do the trick for some women.

Won't be ME that shoots you. I don't use liquor for pain relief, but it does work wonders for the primip who can't/won't sleep and who isn't yet contracting effectively. I carry Jagermeister in my birth bag, and it works GREAT!!! I discovered this when a midwife friend in another state was experiencing premature labor for the third pregnancy. She was determined to keep this baby in as her last baby had hyaline membrane disease. The clerk at the liquor store was quite curious why a preg woman was looking for liquor. He was German and recommended Jagermeister. He pointed out it has a number of herbs in it, one of them being Valerian (for the non-herb-using midwives out there, Valerian is nature's Valium--a very effective sedative), and he stated that Jager is what they use in Germany for premature labor.

All it usually takes is 2 tsp (since she has been alcohol-free for at least several months and Jager is quite strong).

St. John's Wort to Suppress Prodromal Labor

I have seen St. John's Wort used quite a bit in pregnancy, especially for false labor.

Vicodin to Suppress Prodromal Labor

Vicodin is an opiate, class B in pregnancy (A being no risk, but no drug is ever classified A), with risks being addiction with repeated use and uncertainty of slight increase of birth defects if used in the first trimester. It starts acting in 10-20 minutes and last 3-6 hours. It acts directly on the cough center in the brain to suppress coughing. It crosses the placenta and can cause respiratory depression which is what you would have to worry about in the baby is born during the peak action.

I took Vicadin when the dentist gave it to me (i had teeth pulled). It made me feel nasty, out of control and when i got up to pee i fell off the toilet...(people actually abuse this drug??!!) There HAS to be something more natural..that out of control feeling is just what i wouldn't want when in labor!

Not everyone gets that feeling but any drug can give some unpredictable effects. For instance, I have an old neck and back injury from a car accident which causes muscle spasms and lots of headaches especially when I am tired. I have had instances where narcotics were given to help but can't take vicodin -- it gives me worse headaches. Over the years, I have learned to cope with other measures thankfully.

For prodromaling labor, I like the combo of St. Johns Wort, Valerian, Skullcap (a good relaxant and pain killer!) alternated with a bit of Motherwort. It can be used every half hour if needed.

Some women can get some sleep if they use Benadryl early on (25 to 50 mg) which is pretty safe as far as I know. For some women, a little bit of wine and a hot tub bath or massage may also be just the ticket.

In hospital practices, morphine (10 to 20 mg) is sometimes used to induce rest with prodromal or prolonged latent phase labor and I have seen plenty of women given it who get good rest and subsequently wake up in good labor, often having dilated already to 5 cm or so. Sometimes women are also given Seconal but I don't like barbiturates -- it takes a long time to get them out of the body and they can actually decrease pain tolerance if they are still on board and the woman goes active. However, it is unlikely that you would have access to this at home anyway.

I think that helping women find a way to sleep when they are getting worn out from long prodromal/latent phase labors is pretty important and warrants finding as many safe effective tools to help it happen as possible whatever the setting. This can make the difference between vag birth and c/section in many instances or the diff between being able to hang out at home vs. having to transport for pain relief/augmentation later due to a tired, stressed out mom.

Other Remedies

See also: TENS for Prodromal or Inco-ordinate Contractions

I have had great results with homeopathic Caulophyllum for stopping the intense prodroming.  If the body really is trying to go into labor it will also kick it over, so if you don't want a 36 weeker, you may want to wait, just in case.  Something else I have used is Valerian, great as a smooth muscle relaxer.  I use it with my asthma kids and diarrhea also.

I have found that prodromal labor often reflects a malposition ( along with the being late, and not ripening ).   Try pulsatilla (I use 30C q 15 mins 3 times)  Or go in vaginally and try to change the position, while you use your other hand to maneuver the head abdominally.

After ten days of prodromal labor, I tried a supplement called "Master Gland" that someone recommended to our midwives.  You can get it at your health food store.  Baby was born within 24 hours of starting it, if I remember correctly.


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