How to recognise pauses during labour?

Pauses during labour come in many different shapes and forms. Whenever labour slows down after it was previously intense, and mother and baby are well, this can be considered a healthy pause (physiological plateau). For example, imagine that the labour surges are already clockwork regular and strong, and then they gradually become less frequent, less regular, or much weaker – or disappear entirely for a while… then, after an hour or two, the surges slowly reappear and become regular and intense again. This is a typical example of a plateau during labour. Other times, the neck of the womb (called cervix) may have been opening up (dilating) continuously, but then stays the same for a while, or even becomes a bit smaller again. This is also considered a plateau, sometimes called cervical reversal. Plateaus during labour can also look like everything is very intense and overwhelming and then, things feel calm and easy again. The body has many different ways to take a pause during labour, and it is a good idea to listen to what the body needs.

Which terms are used for pauses during labour?

Pauses that occur naturally during labour are called physiological plateaus – simply meaning that things slow down (plateau) and that this is healthy (physiological). We use the term physiological plateaus as an umbrella term for all kinds of natural pauses that can happen during labour. Some pauses also have their own names… for example, when things slow down late in labour, midwives may call this rest and be thankful phase or lull during transition. Other times, when the neck of the womb gets smaller instead of dilating, this might be called cervical reversal or cervical recoil.

Overall, there are lots of different terms for natural pauses during labour, but not much shared language. This is a big problem, because when we lack shared language for a phenomenon, we cannot effectively talk and learn about it. This is why we are advocating to use the term physiological plateau as a catch-all term until we have sufficient research on this topic, or until women tell us that they prefer another term (we are currently asking women for their favourite terms for pauses during labour). Of course, every language uses different terms. The image below gives examples of English terms alone, so you can imagine the multitude of different terms globally…

Can pauses in labour be a sign that something is wrong?

Yes, and no. Natural pauses during labour are not a sign that something is wrong. They are a way how the mother’s and baby’s body adapt to the effort of labour. Sometimes though, pauses can indicate that the birth environment is not quite right. For example, it might be noisy and busy, preventing the body to go into the natural flow of hormones that is required to start and sustain labour. For labour to work well, most women need a quiet and safe space, with as few interruptions as possible. Pauses during labour which happen for reasons that are not a birth complication but have to do with the birth environment are normal and common.

Rarely, birth complications can occur that might initially look like a natural pause although they aren’t. One such possible labour complication is labour arrest (also called labour dystocia, cephalopelvic disproportion or many other terms). Labour may arrest entirely if the baby is not in a suitable position to be born (such as having its arms above its head and trying to be born headfirst) – this type of complication usually requires the baby to be born by a caesarean section. 

Midwives and obstetricians can safely distinguish physiological plateaus from birth complications. When you have a midwife or an obstetrician supporting you during labour, and things slow down, you do not need to worry – simply trust that your body knows exactly what it does. And trust that your health professional will recognise if there is a complication that needs stepping in, and will advise you if this happens.

Why dedicate a whole website to pauses in labour?

Glad you asked! Pauses during labour are mind-numbingly normal and at the same time breathtakingly new… Pauses have always happened during labour and midwives and obstetricians are familiar with this phenomenon since ancient times. But in the past 70 years or so, we have seen a development in maternity care that tends to “actively manage” women’s births. Today, when things slow down in a woman’s labour, this is often seen as an unnecessary delay. And it became common to recommend medical interventions to speed labour up again – so-called labour augmentation. Labour augmentation can include an artificial rupture of membranes (opening the water bag around the baby) or an oxytocin drip (medication to intensify the surges), but also other medical treatments. Such labour augmentation is common, affecting between 30% to 80% of women who birth in high-resource countries, globally.

However, research suggests that when labour slows down, something important is happening – such as the baby changing positions – and that artificially speeding things up can cause more harm than good. We also know from decades of high-quality research that too many unnecessary medical treatments are given to women who birth. Unjustified medical treatments carry risks and can cause complications, which often makes even more medical treatments necessary – a vicious circle, called intervention cascade. The global trend of over-treatment is also called childbirth medicalisation and the World Health Organization and other organisations have already flagged this as a huge problem in maternity care. Childbirth medicalisation is visible, for example, in rising numbers of women having a caesarean section, and fewer and fewer women experiencing a healthy vaginal birth (see graphs below).

This is exactly, where this knowledge hub about physiological plateaus comes in. If we accept that the body can make pauses during labour, and that these pauses are valuable, then we do not need to step in when it happens! Not stepping in means less labour augmentation, a reduction of preventable harm, and fewer preventable caesarean sections. This website is part of our larger effort to shift attention to the phenomenon of physiological plateaus, because we are convinced that this will help more women and families achieve a healthy and positive birth experience.