A case study of a prodomol labor
Prodomol labors are classified as a variation of normal however are they truly? In this case study, I will use my observations of having attended over a thousand births to demonstrate how observing a mother’s labor patterns - whether symmetrical or asymmetrical - together with her physical signs will give you quite a lot of clues as to how the body is communicating with us. It will be helpful to familiarise yourself with this section of our website prior to reviewing this case study ”How do you know you are in labor? Recognising normal versus abnormal labor patterns.”
Day 1:
The mother informed us that she had a bit of bloody show in the morning – old blood – and asked if its full moon working its magic!
Day 2:
9.56am: The birth partner informed us that the laboring mother seems to be experiencing a contraction once every 45minutes or so, lasting for 30 seconds but increasing in intensity.
10.18am: The birth partner informed us that the mother is 2.5-3cm dilated at her Obgyn’s prenatal visir and that the baby in a great position and is expected to go into labor at some point this week.
5.04pm: The birth partner messaged to report that the laboring mother has had 5 contractions in the last hour, at about 10 min intervals at the moment and he was wondering if she was progressing faster than expected? Further added that the laboring mother reported that the intensity is about the same so far - relatively painful - but she’s feeling ok in-between.
6.43pm: The birth partner reported that there is reduced activity but still every 15 mins or so (the 1:52 reading is a mistake, it was only about 45 seconds). One of our team of doulas responded to ask them to pace and rest whilst they can.
7.28pm: The birth partner reported that the contraction patterns still seems quite regular, now 6 in the last hour at around 10-12 mins. One of our team of doulas informed them that we’re looking for both the frequency to pick up and intensity of the contractions to increase, and asked if there are any other physical signs to which the birth partner responded that its still old blood.
10.09pm: Final update from the birth partner for the evening “We’re also going to try to get some rest but just a final update, we’re consistently at 6 contractions per hour, and more regularly lasting for a minute or more.”
Day 3:
11.04am: We did not hear back from the couple until late morning. The laboring mother reported that “Last night was uncomfortable cause laying down makes the contractions more intense for me. Couldn't really find a good resting position. Contractions wise we had a couple that were consistently at an 8min frequency at around 3am cause I got up to eat. Didn't time the ones thereafter cause I couldn't wake my partner up. Will start timing the next few once I'm out of bed.”
11.52am: The laboring mother reported that she went to the loo for the 7mins one and missed one in between for 8mins one.
Straight away from what was reported on Tuesday, and the Day 3 screenshot that was sent, it was early clues to malpresentation or malpositioning of baby. So I gave the couple instructions to do the following with the idea of removing the pressure of baby’s head from her cervix and using OMP Pelvic Alignment Protocols to see if we can reposition baby into a better position for more efficient contractions:
1. OMP Reversing Protocols: Combination of 1.4 + 1.5
2. OMP Pelvic Alignment Protocols: 1.1 - 1.6
One of our doulas had a chat with the birth partner over the phone after they have completed one set of the above exercises and reported that “The laboring mother is having a bit of lunch now and they are going to time the next 5. As the laboring mother didn’t get so much sleep last night so hoping she can have a bit of a rest after lunch (pillow between legs!)”
3.07pm: The laboring mother reported “past 6 contractions while seated with an intensity scale of 3-6/7”to which I responded: “Your contraction patterns at the moment are not symmetrical - which means that somehow the pressure of the baby on your cervix is uneven, causing a long early labor. We need to get your contractions to a 'progressive' pattern where the following 'over a period of time' will:
Frequency of contractions gets closer and closer ie. 10/15mins-2/3mins apart
Duration of contractions gets longer and longer ie. 30-90s long
Intensity of contractions increases from a scale of 1-10
Physical signs ie. early labor versus active labor
At the moment, the duration of the contractions you are experiencing should be when your contractions are between 4-6mins apart. So we need to "reverse" the head off the cervix and see if we can reposition the baby's head to move your labor patterns to a symmetrical pattern matched with the appropriate physical signs. So am needing you to do this sequence again however see if you can do the combination of 1.4 + 1.5 for a TOTAL down time of 10-15mins before you move to 1.1-1.6. There is no way to stay down for 10-15mins so you need to go down.... then come up for a breather... then go down again... etc until you achieve about 10-15mins total DOWN time. Longer is better.
After you complete (1) and (2), time 5-10 consecutive contractions and let us know. We are looking for a reset where ctxs would stop for a while to allow to a breather and rest or it will move to a progressive pattern. If it doesn't, then we need to repeat (1) + (2).”
7.21pm: The birth partner reported “Hey guys, sorry we’ve been a little quiet the last few hours. We managed to finish the exercises but we knocked out straight after, catching up on lost sleep from last night.” This was great news as it meant that the second series of exercises worked to recalibrate. Now we needed to see what unfolded post-exercises to see what labor patterns will unfold.
7.23pm: The birth partner reported “I just woke up but she is still resting. From what we’ve recorded so far though, the contractions have spaced out. And from what I am hearing, it sounds like they have intensified but I will let her put it on a scale out of 10 once she’s up.” To which I recommended more of the following when she is up: “It still does look like she needs more reversing protocol - combination of 1.4 + 1.5.”
8.26pm: The birth partner reported that “She has been awake for a little bit. She is definitely feeing a stronger intensity of contractions, and they seem to be coming closer together too. We are yet to do another round of exercises just yet with no other physical signs.” They said that they will do more reversing protocol after dinner.
9.28pm: The birth partner reported “ Updates- Latest few. Haven’t done the exercise yet as we’ve just eaten. Still no other physical signs. She’s still quite uncomfortable but we’re going to give the exercises another go now. Intervals have increased again slightly to 6 mins. 5-6 mins seems like the norm though. Should we try the exercise still if she is at 4-6 min intervals? ” To which I responded “YES” as given that her contractions were 5-6 mins apart, she was still getting asymmetrical labor patterns as the duration of her contractions were still too long for 5-6mins apart and no other physical signs.
10.43pm
The birth partner reported that” they just finished the next round of inversions. We’ll continue to watch and call you guys if anything, but intervals are reaching 3-5 mins now with more old brown mucus.” I was still not happy with the labor patterns but we needed to give it time to see what unfolds.
Day 4
12.11am: The birth partner reported that “Contractions have started lengthening, both in duration and between intervals for the time being. Trying to let the laboring mother rest in between but contractions are getting even more intense than before.
12.20am: The birth partner called me to report that the laboring mother has reached her maximum intensity that she finds bearable so I informed him that one of our Doulas and I will make our way over.
Day 4:
12.23am: The birth partner reported ‘Just going to pass this update through. Duration is consistently lasting 90 seconds but intensity is almost unbearable for her right now.
1am: We arrived at their home. Contractions are about 4-7mins apart, 90secs long, and the laboring mother is finding the contractions intense. More mucus plug but still brown – old blood. Her contractions started slowing down when we arrived because of the change in environment – this was indicative that she was still in early labor to be so sensitive to the environment. So we left them in the bedroom to give her some space to settle in having us around whilst we set up her birthing space in the living room.
2.15am: The laboring mother’s contractions were still 6-8mins in frequency, about 1-1.5 mins long and intense. For that frequency, her contractions were still too intense and too long, indicative of a malpositioned and/or malpresentation labor so I encouraged them to consider having the Obgyn come over to do an ultrasound scan to check on baby’s presentation and position, as well as have a vaginal examination.
We started using warmed rice socks on the laboring mother’s lower back, still in all fours leaning against the bed during contractions and sitting/resting in-between leaning on her birth partner. She is asking about how much more intense is it going to get, how long is it going to take, what to expect next as she is already feeling like she is at the end of her rope.
2.25am: The laboring mother went to the toilet for a pee and had more old brown blood with a slight leak. The parents decided to have the Obgyn come over to do an assessment the situation.
3am: Obgyn arrived. The ultrasound scan revealed that baby’s head is in-between LOP-LOT, and baby’s spine is in-between LOT-LOA. Vaginal examination showed that she is 4cm dilated, stretchable to 5cm during contractions, station -2, fully effaced with membranes bulging. When the laboring mother was lying on her back for the examination, her OP presentation was visible from the slope from her belly button to pubic arch showed a slight dip her the OP presentation is.
3.20am: We all left the room to give the parents space to discuss their options.
3.30am: The laboring mother went to the toilet to pee after which I explained the difference between using the epidural to rest and a cesarean as the birth partner mentioned that she is thinking of the latter. I told the laboring mother that she is not cesarean worthy – she is vaginal birth worthy! Despite the fact that baby’s presentation is in-between LOP-LOT, all other factors are in her favor and she should be able to birth this baby vaginally even if it means an assisted delivery!
3.40-4am: I suggested more OMP Reversing Protocols and this time we did Open-Knee-Chest Pelvic-Floor-Relaxer with all 4 of us supporting the mother.
4.36am: The laboring mother started eating some bread in-between contractions. At one point, she asked her birth partner if he finished eating her bread and all of us burst out laughing even the mother herself as her birth partner defended his innocent 2 bites!
5.02am: The decision was made to transfer to the hospital for an epidural.
The epidural gave the the laboring mother the relief that she needed to know that she can birth her baby without a cesarean. As her labor hasn’t progressed by lunch time, she consented to augmentation and birthed her baby vaginally without assistance before dinner!