Anybody who works around women giving birth will tell you that they have heard their fair share of four-letter words in the delivery room. Even the most mild mannered, polite, and proper of women have been known to let a few choice words fly in the midst of contractions or pushing.
However, there is one word that we feel should be taken out of a women's vocabulary during labor, and that word is "only."
It's a common scenario. Mom's been having contractions all day/all night/all week, and finally gets that feeling that tells her, "it's time," but then she gets to the hospital and the news isn't quite what she expected.
"I'm only 3 cm dilated."
"It's been six hours, and I've only progressed 1 cm."
"I'm only in early labor and not active labor like I thought."
"If I've only gotten this far in the past eight hours, how long is the rest of this going to take? Am I going to be in labor forever?"
"I've only been at __cm for 8 hours. Does this mean I have to have a cesarean?"
The vast majority of the time, the word "only" is used in reference to cervical dilation. The problem with this is that it fails to acknowledge all of the other things that a woman's body has to do before pushing out a baby. Every contraction has a purpose, but that purpose is not always to dilate the cervix. Some contractions work to engage the baby further in the pelvis or to help the baby rotate. During labor, the cervix does four things:
Softening: in preparation for effacement and dilation, the cervix starts at a firm consistency, like the tip of your nose, and softens to allow for effacement and dilation.
Effacement: as the baby's head becomes more engaged in the pelvis, the cervix thins out, or effaces, in preparation for dilation.
Positioning: before labor, the cervix is high and posterior, or facing towards your back. As labor progresses, the cervix moves to an anterior or forward facing position in preparation for delivery.
Dilation: as delivery approaches, the cervix dilates, or opens, to 10 cm. This is also known as "complete." When the cervix is fully dilated, the second stage of labor, or the pushing phase, can begin.
The dangers of "labor math"
Labor math refers to the practice of taking how long it takes to get from one stage and dilation to the other and assuming it will take that long to get to the next stage of dilation. Dilation, however, rarely follows such a linear pattern and labor math is not a good way to estimate how long it will be before delivery. This leads to another four-letter word called, "WHEN?!" Instead, labor math leads to disappointment, frustration, and feelings of dread. Because there are other factors besides dilation that lead up to delivery, there might be an ebb and flow to the progress of your dilation.
What if my labor stops?
You may feel "stuck" at a certain number and reach a plateau, and then proceed to dilate fairly quickly after a period of time. Or not! Using the word "only" to talk about your labor progress discounts the amazing work that your body is doing. It is true that sometimes a lack of progress indicates a need for a cesarean, but usually there are other factors at play that contribute to an OB's decision to perform a cesarean. Unless your OB has discussed a specific concern with you, there is no need to worry if things seem to be taking longer than you expected. If you are feeling exhausted or have another need, don't be afraid to speak up and communicate those needs with your birth team. Your doula can help you talk things through and help you communicate with the staff if you aren't quite sure how.