A reader asks the following question:
I hope that you will address the situation of a mother having quick labors. My labor with my first son was 5 hours and 25 minutes, and I believe would have been even shorter had we been at the hospital sooner. It happened so fast that and we didn’t realize I was so far along, felt the urge to push at home, but did not start pushing until one hour later- thank the Lord for our awesome doula who showed me how to breathe during contractions to keep myself from pushing- and he was born 33 minutes later. With my second son I had “pre-term labor” (well, it is kind of a long story there) anyway, at 34 weeks I was 6cm, fully effaced, with baby at 0 station. I didn’t end up delivering until I was 37wks6d- and he came in under 1 1/2 hours. My water broke at 6am, contractions started up around 6:25ish, arrived at hospital around 7am, got put into l/d room around 7:15, baby arrived at 7:25am. My doctor and doula both missed the birth. I also have had DAYS of contractions preceding both births- real, painful contractions that I can’t just go about my day normally with.
I am not pregnant again currently, but if God gives us more children our doula even suggested possibly having a induction since I go so fast- that way we would be sure to be at the hospital with our doctor and doula present. I’m not sure what I think about it. We live 30 minutes away from the hospital. There are closer hospitals, but we go to this one b/c that is where our doctor practices and he is the only doctor my husband and I feel comfortable going to. It took awhile for me to find him during my first pregnancy. I have type 1 diabetes and had trouble finding an OB that didn’t treat me like a worst case scenario waiting to happen. I have never had any complications with pregnancy or labor and birth (aside from the pre-term labor which is not even due to diabetes anyway). Also, having diabetes, I cannot have a homebirth where I live because midwives will not take me. I am looking forward to your thoughts on this issue specifically and would love to see a post about it. I certainly want my doctor and doula at all our births, I don’t want to give birth suddenly at home unassisted, I don’t want to give birth on the side of the road somewhere, I want my husband to be there (luckily both times I have gone into labor he was home), we need to give my in-laws time to arrive at our house and take care of our young sons (luckily they only live a few minutes away), and I HATE going through transition in the car- it’s awful! Of course I am planning a natural birth anyway, but sitting in a car is not the way to deal with contractions. And honestly if my water had not broken as the first sign I was in real labor I’m not sure that we would have made it to the hospital last time! We probably would have waited through a few contractions to see if it was the “real thing”, then called my in-laws, waited for them to arrive, etc. and who knows where we would have been when I felt the urge to push- which I absolutely could not hold back from this time. So it sounds like it would be nice to have a planned induction, but I also HATE the idea of it, I don’t want to risk it “not working” and ending with a c-section, or take the risk of delivering the baby too early without knowing it and then having to deal with breathing problems or whatever. I am a FIRM believer that babies come when they are ready. It is an interesting position to be in and as I said, I would love to hear your thoughts or be pointed to any other resources regarding this.

This is actually a fairly common predicament.  Most women don’t relish the idea of going through transition in the car, or pant/blowing and trying not to push while hubby is speeding to the emergency room.  How is the best way to handle this when you believe in non-intervention, but you don’t want a roadside delivery?

Short of pitching a tent on the hospital lawn, there are other options.  First, ensure that the cervix feels “ripe” and ready for labor.  This means the cervix should be very soft, preferably easy to reach, and dilated at least 2-3 centimeters.  Women who have a history of short labors will often report dilating slowly over several weeks before labor began in earnest.

Second, the baby should be in the pelvis, not floating high above the pelvic brim.

Third, consider how you might want to start labor.  There are advantages/disadvantages to each method:

• Breaking the water (amniotomy):  this will often start contractions within a short time, especially if you are dilated and have already been having a lot of contractions of and on.  The disadvantages are that there is a small risk of prolapsed cord or increased fetal distress because the protective cushion of water is removed.  The risk of prolapsed cord is greatly minimized if the midwife or physician is careful to make sure the baby’s head is tight against the cervix, and is down in the pelvis reasonably well.  Babies generally do fine in labor even with the water broken.  You should consider how you would feel if the water was broken but you did not go into labor.  Talk with your provider about how s/he would handle this.  How long will they let you wait before inducing you if this would happen?
• Low-dose pitocin or cytotec:  I am not a fan of cytotec.  Although it works well most of the time, the problem is that it is either given by mouth, in which case we can’t reverse its effects if problems develop; or it is placed vaginally, in which case it is also difficult to remove if problems ensue.  Pitocin, for all its faults, is much easier to control in dosage and rate, and can be turned off and is quickly cleared out of your system if problems develop.   I have done many “gentle” inductions by giving a very low dose of Pitocin and then patiently waiting for the woman’s own body to kick in and start producing the natural form of Pitocin, oxytocin.  At the point the cervix begins to dilate or the woman begins to feel painful contractions, the infusion can usually be turned off and labor can progress normally with walking, sitting in the labor pool, or other comfort measures.  Disadvantages of Pitocin are: the potential for causing fetal distress if it is given too much/too fast; needing to be continuously monitored while it is being given; requires an IV to be started.

Other options could be stripping the membranes (done by the midwife or physician).  This could be done in the office early in the day, then have the woman go for a long walk and come back to be checked a few hours later to see if cervical change has occurred.  A combination of stripping the membranes and taking 2 tablespoons of castor oil mixed into a thick milkshake will usually get labor going within a few hours if the cervix is dilated to at least 3 cm. and is soft and ready.

Using a breast pump to stimulate contractions is another option for coaxing labor to start.  Using a double pump, if available, pump the breasts until you feel a contraction begin.  Then stop pumping.  Wait until the contraction is gone, then begin pumping again and repeat the process.  The objective is to achieve 3 contractions in a 10 minutes period.  This process can take a while, because it is working more naturally with the body’s own oxytocin to start labor.

One option I would consider if I had history of rapid labors and lived some distance away is getting a hotel room close to the hospital, having my membranes stripped, and taking castor oil.  This way, you’d have 24 hours for contractions to begin, but could be comfortable in your hotel room, yet close to the hospital.

Two women I’ve cared for in the past have requested induction for rapid labors.  The first, having her second baby, told me she’d felt no pain whatsoever with her first labor and did not even know she was in labor until she felt the urge to push.  She barely made it to the hospital.  She was terrified of having the baby alone, and asked me to break her water.  She came to my birth center dilated to 3 centimeters.  We broke the water, and then I planned to send her out to take a walk until contractions started.  I gave her a sanitary napkin to wear and she went into the bathroom to put it on before taking her walk.  When she came out of the bathroom, she said “I am feeling some cramping”, then doubled over and needed assistance to walk to the bed.  Within minutes, her baby was crowning, and born easily with only a push or two. (I know, all you ladies who have 36 hours of labor, it’s not fair!)

The second woman was having her third baby and began dilating at about 34 weeks.  By 39 weeks, she was 6 centimeters dilated, but not in labor.  She begged me to admit her and break her water.  I had another woman in labor that day, so told her to come on in.  We broke the water and I told her I was going to go check my other labor patient.  I no sooner walked into the other woman’s room than I was paged with the message, “Your patient has to push!”  I hurried back to her room just in time to catch the baby.

I would love to hear from women with history of rapid labors if you have other creative ideas of dealing with this situation while keeping birth as normal as possible.