Fast or Slow? Which Labour is Easier
A sentence like “I was in labour for 30 hours” usually elicits a groan of sympathy for the suffering of a long, slow labour. Whereas “the baby came in under 3 hours!” prompts admiration and envy for such an efficient effort.
There is a ubiquitous sense that a long labour is worse than a short labour, and that the best kind of birth is a quick one. Which makes sense if you are only measuring labour by hours, and nothing else. Obviously enduring more of something painful is worse: being in pain for 20 hours is obviously more horrible than being in pain for 2 hours.
But longer births are not always worse, and shorter births are not always better.
To understand why, we have to take a step back from the assumption that more hours of labour is simply more hours of pain, and look at what else is going on. Here are five reasons why faster and slower labours each have their own particular upsides and downsides, and neither one is inherently easier or harder..
From Here To There
Imagine that labour is a certain number of kilometres that you have to travel on foot, let’s say 50 km. The quickest way to span that distance might be to run full tilt, all out, sprinting as fast as you can. But would this be easiest? Walking slowly might take longer–probably a lot longer!--but it is not necessarily harder. The fact that it would take many hours means you might miss some meals, you might miss more sleep, you might feel more mildly weary simply because of the amount of time that’s passed, but none of these things would be as acute as the frantic, breathless, exhaustion of running the 50 km.
Labour is like this too. There is a certain amount of physical change that has to happen throughout first stage labour to prepare for the actual birth, which includes the ripening, thinning, and dilating of the cervix, the regrouping of the uterine muscle to the fundus, the positioning of the baby, the softening of the pelvic joints, and the accumulation of a lot of hormones. Doing this at break-neck speed is like running as fast as you can, whereas going through these changes at a slower pace can feel gentler on the body and allow you to catch your breath a bit throughout the process. It has the potential to be calmer, and less frantic.
Focus
Think of how your speed might affect your focus during the journey. If you’re walking, you might be able to eat on the go, you might be able to talk, you might be able to tend to your basic comfort needs like removing a jacket or putting on gloves. You might be able to pause to tie a shoelace or apply a bandaid. But if you’re sprinting at full speed–nonstop–you might not be able to do any of those things. All your energy and focus might be committed to just the run itself, which means you might be enduring being hungry, thirsty, or overheated the whole time. You might not be able to tend to your shoelace or blister. You might not even have the breath to communicate what you need because you’re racing too fast.
In labour this can be true as well. Sometimes really fast labours leave people breathless and spent, so they can’t find the words or the energy to communicate what they need between escalating contractions. It is often harder to eat or drink during a fast labour, harder to rest, harder to get comfortable. The energy is so focused on getting there that it can be really challenging to do anything else at all. It can be like you barely have time to breathe, let alone have a drink or fix your hair elastic.
Hormones
The speed of the labour also affects your experience of the hormones, or more accurately, how the hormones affect your experience. A very long labour (sometimes called a ‘prodromal labour’) escalates very slowly. The incline is minimal, and there is lots of time to get accustomed to the rising levels of intensity. This is partly because one of the hormones we produce in labour – endorphins – are like nature’s narcotic. They help us feel good, and they help us zone out and achieve a trance-like state where we can keep ‘doing’ without thinking. We produce this same hormone when we do endurance exercise, like running, cycling, or hiking, and you might recognize that dreamy mental state where you can keep moving without really being in your conscious brain.
But occasionally we hit a ‘wall’, which means the exercise has gotten ahead of our endorphin level. When we hit a wall, we snap awake, and we think we can’t go on. We feel done. We become overly aware of being tired, or just wanting to quit. But if we do keep going, the endorphins usually catch up pretty quickly, and we can slip back into that peaceful zone where we just continue on without thinking about it. The ‘wall’ crumbles and we forget it was ever there.
If you’re sprinting, on the other hand, you never sink into that peaceful endorphin state, because your exertion level is always ahead of your endorphins. You have to mentally prod yourself mercilessly the whole time, and you can’t rely on this natural feel-good hormone to help you coast. The effort is mental on top of physical, and both are acute.
A fast labour (sometimes called a ‘precipitous labour’) can be like this too. The intensity of your contractions can escalate so quickly that your endorphins never have the chance to catch up. Many people with fast labours don’t get the benefit of drifting in that trance-like state of semi-consciousness that helps us cope with the contractions, because the endorphins are outpaced. The endorphins lag behind because your labour is racing like a runaway train, so you don’t feel their benefit until after the baby is actually born.
Intensity
Needless to say, this can make a fast labour feel more intense than a slow labour. Believe it or not, a long slow labour can be relatively gentle and soft compared to the whiplash race of a fast labour. If labour is moving very quickly, everything happens at break-neck speed and there is no chance to relax. The contractions feel closer together, and people often report that they don’t get as much feeling of rest and recuperation in between.
As a result, slow labours can feel comparatively languorous, meditative, and relaxed. Whereas fast labour can feel extremely intense, like you can’t catch your breath or orient yourself in the process. So the idea that 30 hours of pain is worse than 3 hours of pain doesn’t really capture the difference. It’s more like if you have to achieve one painful thing, doing it slowly and gradually can sometimes ease our bodies through the process more gently than trying to rush it through without pause.
Comfort Measures
One of the results of this intensity is that different comfort measures work better for different labours. People with slow labours often enjoy baths, massage, slow dancing, soft music, swaying, relaxation techniques, and leaning positions. Whereas people with really fast labours sometimes feel too much intensity, and too much sensation too quickly, and they don’t want to be touched all that much. Sometimes they can’t get into the mood for baths or massage or slow dancing. So preferred coping techniques are often pacing back and forth, verbal coaching, words of encouragement and support, squeezing combs or spike balls, TENS machine, the shower, cold packs, lots of water or electrolyte-beverages, and upright positions.
Here are some common preferences associated with labour speed, but please note that these won’t be true for everyone. This is not a list of ‘shoulds’ during labour, just stuff to try. Always customize techniques so that they work for you, and if something feels wrong, don’t do it.
Other comfort measures, such as dim lights, are useful for any labour speed.
It might be more obvious that there are also particular challenges more commonly associated with long labours. One is fatigue, since labouring for days and days can cause exhaustion in the birthing person, the uterus, the baby, and the support team. And sometimes fatigue can lead to its own complications, such as labour stalling. But just like any labour, the speed alone doesn’t guarantee if it will be a positive or negative experience.
The assumption that a fast labour is always the winning lottery ticket, and a slow labour is the worst kind of labour imaginable, is not accurate. A fast labour isn’t inherently better or easier than a slow labour, and neither is it worse. Any speed of labour has its upsides and downsides. And there are many things that can affect your labour other than how long it lasts. Most births are really, really challenging, and some births are really, really joyful. And sometimes these are the same ones, no matter how fast or slow.
Stephanie Ondrack is a retired birth doula (or maybe on an extended sabbatical) and has been with The Childbearing Society since 2003. She lives in East Van with her partner, kids, chickens, and cats.