3 common reasons labor stalls when women check in to the hospital
The roles of trance, light, and perceived threat
There are at least two major issues with the current state of hospital check in for women in labor.
Those who know my work, know my first issue well: the lights.
We’ve long since established that too bright of light, or light in the wrong wavelength slows contractions and makes them more painful.
So, we need to tune the lights in the birth suite (including the check in areas) to accommodate the known need for a calm, dim, cave-like environment.
The other problem is the vaginal exam, required at pretty much every birth center.
This is a function of impersonal care.
Compare: a good midwife working with a woman she knows well and especially a woman she has seen give birth before, can usually guess by ear how far along a woman is into the labor trance. And in a midwifery context, if the birth team arrives too early, they can simply go home and come back later. However, once a woman checks into a hospital, she can’t easily go home. Therefore, the consequences of checking in too early are much higher in a hospital system, and the vaginal exam at intake exists to prevent that.
The variability in how a woman presents—like being very calm despite being very close to birthing, or very distressed in spite of being hours or even days away from birthing—and the lack of continuity of care combined with the demographic sway towards more first and second time moms and fewer experienced moms giving birth… mean a more objective method of determining “progress” than by ear and intuition, ie, the vaginal exam, is now used to decide if a woman is eligible for her insurance to pay for birth support yet, or not.
But remember, regulations require tracking dilation in spite of the fact that labor dilation is not linear and normal and healthy timelines vary greatly! Any circle of women sharing their birth stories will prove the dilation greatly varies woman to woman and even labor to labor. One woman will do in days what will take another mere hours.
Looking at this intake process question at the statistical rather than individual level makes sense when you overlay that from a billing standpoint, a shorter labor support time is objectively “better” than a long one.
So the vaginal exam at intake, in spite of its problems, is enforced because it prevents women from getting expensive-to-deliver care in early labor that would crowd the birth center and cost more whether from insurance or out of pocket expense.
These two issues of bright light and routine vaginal exam at intake both disturb privacy—an overlooked ingredient to instinctual birthing biology.
To load a laboring woman into a moving vehicle out in public, through a hospital check in process often staffed by strangers and brightly lit by LED lights, and then into a birthing space itself staffed on a rotating schedule where she likely won’t know the nurse(s) and possibly may not even know the doctor in charge of her care is very much disregarding a woman’s usual preference for privacy in labor.
As so many have learned from Ina May, birth is an unconscious, sphincter led response.
From the intake process, I have observed an anemone-like response where a laboring woman clams up, most especially if she is not yet deep enough into the labor trance to have lost touch of normal social behaviors.
Below are the primary mechanistic factors I can tie in to what I’m criticizing about the standard hospital check in process:
trance state effect where social norms are numbed from the transition stage onward, but not before
individual sensitivity to artificial light (estimated at a 50-fold range in measured melatonin suppression from the same exact lux level depending on the person)
variable responses to the sight of medical equipment and whether that equipment feels like safety or a threat
The above factors explain why some women can go through this hospital check in process and still push their babies out within ten minutes of arriving (and I do hear of this all the time). They are already deep into the trance and the medical setting feels like safety and the light isn’t having that strong of an effect on their biology.
But the moms who go in before that trance has fully set in, and especially if they also perceive the medical setting as threatening, and additionally sit on the more sensitive to artificial light side of melatonin suppression curves, these moms may have a very very difficult time ever settling in to the labor trance at all after the anemone response (or sphincter contraction, if you will) from the bright and privacy-invading check-in process. These are the women I hear from over and over who had a labor progressing fantastically at home, but that stalled at the hospital and didn’t recover without intervention.
My recent light and labor class talks more about how the lights actually should be, and how to protect yourself from hospital lighting if you do decide to birth in that setting.
I’d love to hear from moms and birth workers in the comments about how they experience the hospital check in process, and how it could potentially be improved in the future.
Link to my recent light in labor class here:
https://www.brighterdaysdarkernights.com/p/how-to-use-light-and-darkness-in