I was sitting tea in hand and tummy full of garlic butter penne, on twitter, when a chat popped up led by Sheena Byrom (all round awesome midwife, RCM chair and OBE).
It was about latent labour. ''Yes'', I thought, ''procrastination for the win...''
Latent labour is hard. It's almost impossible to diagnose for sure. It was a fascinating, heated twitter debate - and this post shows the conclusions I came to.
Bear with me, because this metaphor sounds a little odd. But I think it'll help with the way you think about latent labour.
Disclaimer: this post isn't on the physical ways to help with latent labour. I learnt plenty of new approaches on twitter (rebozo anyone?) but you can find those all over the net. This is specifically addressing the psychology of how we care for women in latent labour.
To me, diagnosing latent labour is like diagnosing whether someone's in love, or in lust.
The only thing that will help you decide is time. And it's really personal.
NICE says latent labour consists of 1) painful, regular contractions which can stop and start, and 2) some cervical change, up to 4cm
Loads of midwives have issues with this definition as 'labour' makes it sound like a woman's definitely on her way to birthing.
When really, the 'stages' of labour that we talk about are just ideas, based on some fairly patchy research from 45 years + ago. Latent labour as an idea has even less evidence behind it.
In reality, when we say 'latent labour', we're making a not-very-educated guess about when a birth might happen.
Women can contract for weeks and weeks and be no closer. Or alternatively, some birth on the bathroom floor at their in-laws' house on Christmas day with barely a warning (Hi Sarah, old housemate of mine 🙂 ).
So it's understandable that some midwives say the concept of 'latent labour' is unhelpful.
Other midwives say it's the best concept we've got to help women and carers make up their minds about how best to deal with pain or expectation when it looks like it's going to be a while.
Whatever your thoughts, it's important to realise the system isn't great at looking after women psychologically during this time.
The wonderful midwife blogger Rachel Reed rightly points out we give women mixed messages. Stuff like:
''Don't leave it too long if you're contracting regularly, we don't want you having your baby on the way in!'' along with ''But I'd go home for now, and stay there as long as possible, it's the best place for early labour!''
Add a potentially painful car journey and/or vaginal examination and you can see how women might feel they're having a bad day.
Plus, if a woman feels safer in hospital and wants to stay, it's usually not possible before she's 4cm. Staffing and space just isn't up to it.
We often make women demoralised by sending them home because they're not ready for 'proper' labour care. All of this disappointment and hassle can knock a labour right off.
So what's a busy and caring midwife to do, faced with all of these latent labour issues?
How do we stay empathetic and open, supportive and reassuring, when we have few definite answers for women asking us about an intimate, personal journey?
I hope my metaphor will help you cut to the heart of what midwives can actually do to help, no matter how busy you are.
In my opinion labour is as unpredictable and undefinable as being in love. Hormones stimulate a wild and world-changing journey that's led by your body and subconscious. And it's different for everyone.
Latent labour is like being in lust. All the hormones are the same as 'real' labour. It's early days, but it feels the same, especially if you've never been in love before. And it can turn into love at any moment. Often you won't be able to work out when it changed. You just know that it did.
If we think about it in these terms, we're far less likely to forget how exciting/terrifying/unexpected it feels for the woman.
We also know, when we're beginning to fall for someone, how painful it can be to hear ''it's not **real** love''. And also, we have no right to say this! It might be the real thing. Our definitions aren't up to much.
So how about we listen as much as possible? Let the woman tell her story, and she'll own it and be able to make an informed decision about what to do.
We could say:
How wonderful - it might be starting! But, many women experience what you're going through, but realise afterwards it wasn't labour. That doesn't mean what you're going through isn't just as intense as established labour. Can you try and embrace the experience as much as possible, without knowing for sure the baby's coming?
Even in the busiest of labour wards or triages, this attitude of respect for what a woman's going through is the best care we can offer.
I know it'd be great to change the way we assess women. Special areas for women latent labouring to help them stay stress-free. Home visits to do early labour assessments (as the RCM suggests). Ultimately, more home birth would be the best way of keeping the hormones flowing, and then we'd need less assessments anyway....
This isn't the reality of most modern maternity care systems. I know - it's so hard.
But this gentle approach is far more likely to keep labour alive, rather than knocking it flat.
I would so love to hear what you think about this.
Aspiring midwives, what part of this metaphor do you find most helpful when thinking about latent labour?
Qualified midwives, how do you give emotional support when pressed for time and caring for a latent labourer?
Please leave me a comment with your thoughts so we can discuss this further.
As always thanks so much for reading...if you liked this article do consider sharing it with a midwifery mate, or even subscribing to Midwife Diaries so you'll get posts to your inbox, and the occasional email when I've got something really important to tell you 🙂