Keeping Labor Moving:
by Renee Mandala, M.D., CD (DONA)

So many women seem to have problems in labor, leading them to have cesarean surgery to give birth. How is it that so many women today cannot deliver vaginally? What can I do to avoid a cesarean section?

The number one cause of a primary cesarean in the U.S. is failure to progress in labor (dystocia). First, it’s important to note that a recent study showed that nearly 25% of cesarean births performed for "lack of progress" might be carried out too early in labor. This practice is contrary to the American College of Obstetrics and Gynecology’s recommendation that the cervix be dilated to 4 cm or more before a diagnosis of lack of progress is made.

The main cause of failure to progress in labor has to do with the baby being malpositioned. There are many non-invasive ways to work with a malpositioned baby before labor and in early labor that can set a smooth course toward vaginal birth. The earlier these measures are taken, the better, as we’d like to help baby to rotate before she becomes engaged in the pelvis. However, I’ve worked with many women whose babies have successfully turned later in the birth process.

Maternal positioning and patience are often the answer for a slow to progress labor. A few strategies for rotating and realigning the baby are for the mother to:

  • Avoid semi-reclining positions
  • Spend time on hands and knees, pelvic rocking
  • Slow dance
  • Kneel, sit, or stand while learning forward

    Left in a safe and supported environment, many of my clients naturally gravitate toward these positions, and my job is just to encourage her natural intuition.

    In the hospital setting, the very high use of epidural anesthesia during birth can prevent these babies from rotating due to their mothers’ immobility. Therefore, it is recommended, in order to encourage labor to progress, the use of an epidural be delayed or avoided. However, even with the use of epidural anesthesia, one should not rule out the possibility of positioning the mother in ways to assist rotation.

    A vital addition to my doula "bag of tricks" is Penny Simkin’s fabulous resource "The Labor Progress Handbook." This book focuses on ways to prevent dystocia and to manage and treat it before it becomes severe, reducing the need for more complex interventions. It describes positions, movements, and techniques based on principles of anatomy, physiology and psychology of childbirth. As a doula, I am certain that this little book has assisted me to help a number of my clients avoid and diminish labor dystocia and birth their babies vaginally through early natural intervention.

    Renee Christine Mandala, M.A. CD (DONA) is a Certified Birth and Postpartum doula. She holds a Master's Degree in Spiritual Psychology with an emphasis in Consciousness, Health & Healing. Renee provides heart-centered care through the transformational journey of birth and early parenthood. She is currently undergoing cerification with the UCLA Lactation Educator Program.