You have a vision of what you imagine your labor going like. There is always the possibility that your birth does not go as planned due to circumstances out of your control. It can cause anxiety for your birth to go another route you were not expecting. One possibility is precipitous labor and birth. This is when your baby is born within three hours of your labor starting. You can think of this article as some emergency planning just in case you end up with very short and fast labor and birth. Learn about the risks of precipitous labor, get some tips if you do find yourself in this scenario, and how to process your birth experience afterward.
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Typical Duration of Labor
There is a big range of how long labor can last. Typically, “normal” labor for a first-time mother is between 3-30 hours. Less than three hours is considered precipitous and more than 30 hours is considered prolonged. For mothers who are not having their first baby, labor tends to be much shorter. For second or more babies labor tends to fall between 3-15 hours, and more than 15 hours is considered prolonged.
A review of 37 studies including 208,000 women gives us more data on labor duration. First-time moms had a median duration of 3.7-5.9 hours when measuring time started from 4 centimeters. When measuring from 5 centimeters 3.8-4.3 hours. The second (pushing) stage median was 14-66 minutes for first-time mothers and was much shorter for second-time mothers from 6-12 minutes. A systematic review that included 18 studies reviewed duration of active labor in low-risk women. These studies measured active labor from between 3-5 cm and the average was 6 hours.
It is one thing to measure labor in a clinical setting from measurements taken from a vaginal exam. It is another thing for individuals to subjectively measure the length of their births. In my first birth, I started contractions around 7 p.m. and my son was born at around 1 pm the next day. This could be considered an 18-hour labor. I tend to think of it as more of an 11-hour labor and start the clock from when I couldn’t sleep and when contractions became more challenging to manage.
Your labor and birth will be a unique experience. How you experience the pain or discomfort of contractions and how you measure your time in labor is subjective. There is no way to know how long you will be in labor. If this is not your first birth your previous births can give you clues as to what to expect and subsequent births tend to be shorter. Even if this is not your first baby every labor and birth experience will be different, not just in the length of time but also in how you experience it.
We have covered prodromal labor and this involves contractions before labor starts. It can be tricky to tell the difference between prodromal labor and actual labor because contractions can have a somewhat regular pattern. They can start and stop at about the same time each day, and this can last for days or weeks before your labor starts. For someone experiencing prodromal labor, it can feel like you are in labor for days or longer.
Labor can be really long, but it can also be very rapid. Precipitous labor is most commonly defined as a birth within less than 3 hours of the start of regular contractions. Some references count it as a birth under five hours. Precipitous labor or birth is much shorter than the average or typical birth. It may seem like a blessing to have a short birth, but it also has some risks and downsides.
The goal of learning about precipitous labor is that if you were to encounter this you would know what it is. Being educated is empowering because you can be more confident going into a situation you are aware of. On the other hand, you can feel like you are out of control in a situation with unknowns and a lot of uncertainty.
Causes of Precipitous Labor
There are a few theories as to why some mothers have precipitous labor. It could be from one or a combination of these. The first is that there is low resistance of the birth canal. A fast labor could be due to abnormally strong contractions. The last reason is that there are not painful contractions. Think back to when you start the onset the labor. If you are in labor but you are not in any pain or discomfort, things could be progressing more quickly than you realize. In this case, by the time you are having really strong contractions you may be very close to meeting your baby, which makes your experience of labor very short.
Evidence on Precipitous Labor
In a study in Japan of 11,239 births, 14.3% were precipitous deliveries. This is a much higher rate than we see in other studies. The study authors noted that the high incidence in this study may be attributed to the different definitions and the diagnosis of regular contractions.
Precipitous labor was less common for first-time mothers, which had an incidence of 6.9% and was 21.5% for mothers not having their first baby. The technical term for a first-time mother is nulliparous and parous refers to the second, third, fourth, etc. baby. For anyone afraid of having prolonged labor, this study found that for first-time mothers only 0.5% had prolonged labor.
For the women in this study with precipitate deliveries, they were more likely to be younger, at a lower gestational age of delivery, not use oxytocin, have a baby with lower birth weight, and have hypertensive disorders. The good news is that they found no significant differences between the two groups regarding maternal or neonatal complications.
Risks of Precipitous Labor
While the prospect of short labor may be enticing, it does come with some risks. There are some reasons why birth is a long process. The time in between contractions gives you time to rest in between managing pain of contractions. In very short labor you may suddenly find yourself with closely spaced contractions where you do not get a break.
A longer duration of birth also gives your vagina and perineum time to stretch, which can prevent tearing. In a precipitous birth, you could be at a higher risk for tearing or a laceration to your vagina or perineum which can be uncomfortable and increase your recovery and healing time after birth.
Someone who goes through very short labor can also be at an increased risk for postpartum hemorrhage or placental abruption. Precipitous labor is characterized by very strong contractions and this may lead to uterine atony after birth. The muscles in the uterus work very hard during labor and birth and you still need strength in those muscles after birth for the third stage of labor, to birth your placenta. Uterine atony happens when the muscles do not contract after birth which is needed to prevent postpartum hemorrhage. Those contractions help to close off the blood vessels that are exposed after your placenta detaches from your uterine wall.
In addition to risks to the mother, there is a possibility a baby born in precipitous labor is at a higher risk for shoulder dystocia.
This is when a baby’s shoulder gets stuck during birth. Most of the time this can be resolved but there is a risk for injury to mother and baby. There is a risk that a baby born very quickly has aspiration of amniotic fluid. While it is rare, a precipitous birth may increase the risk of intracranial hemorrhage.
Labor Outside of a Hospital or Birth Center or an Unplanned Home Birth
A common risk noted for very quick labor is a risk of a baby being born in a non-sterile environment. If your labor progresses very rapidly it is possible that you do not make it to a hospital. Keep in mind that many babies are born in settings that are not sterile. Your vagina is not a sterile environment. While having a baby in your car on the way to a hospital may not be ideal, I would be the least worried about the environment being sterile.
Not making it to a hospital may be more of a concern if you live far away. If your labor is progressing very quickly and you feel like you should go to the hospital right away, trust your gut. Call your doctor or midwife and let them know that you are coming in, or if you are planning a home birth that they need to come to you. While there are a small number of people who do end up having a baby at home when they didn’t plan for it the vast majority of those mothers and babies are perfectly healthy. On the bright side, it will make for a great birth story. You can always call 911 and have emergency responders there to help you.
Precipitous Labor and Pain Medication
Some mothers that have precipitous labor may not have time to be administered pain medication. If you are planning to have an epidural this may sound like the worst-case scenario to you right now. My goal is not to scare you, but to give you a heads up, in the event this happens to you. If you find yourself having very fast labor and you want pain medication please advocate for that. I trust your doctor or midwife and the anesthesiologist on call will do their best to make that happen. On the upside, if you are unable to get pain medication these births do go quickly.
Emotional Processing and Postpartum Depression
A big outcome that is often not accounted for in research is your emotional well being and satisfaction with your birth. Having very rapid labor can leave you feeling overwhelmed and as everything progressed quickly out of control. How you reflect on your labor is very important and should be given attention. It can take time to process everything that happened after the fact. It could be helpful to debrief with your doctor or midwife and talk about what happened. This also gives you an opportunity to ask questions and get answers to things you would not have time to do during your labor.
We all experience birth differently and we process our experience of it in our own way. It can be upsetting to reflect back on a birth that did not go as planned and it is okay to be upset. If you are having a difficult time processing it or you think you may be experiencing some baby blues or postpartum depression please bring it up with your doctor or midwife.
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