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Orig­i­nally pub­lished Sep­tem­ber 2012, Path­ways to Fam­ily Well­ness Magazine

Not every labor is a marathon; some take only a few hours. But are these so-​called pre­cip­i­tous births really abnor­mal, or are they more com­mon than we think?

Soon after I began assem­bling a bed frame, which I thought would be a good labor project, my con­trac­tions started. I was excited, and decided to time them. The clock showed 1:22 p.m. After hav­ing two waves about five min­utes apart, I shared the news with Gus, my hus­band, so we coulad give our mid­wives an early heads-​up. Our daugh­ter, Zoe, had been fast for a first-​time birth, and we knew that sec­ond births are often faster.
We paged Chris­tine, our pri­mary mid­wife, at 1:37 p.m., and told her that the waves had just started, but not to come yet. We agreed to touch base in 30 minutes.

I went back to my labor project. But the waves started com­ing faster, and I couldn’t focus any­more. Mean­while, Gus was mak­ing arrange­ments for our birth and get­ting the place ready as quickly as pos­si­ble. He called my mom, and asked if she could come and look after Zoe.

While Gus made us lunch, I was pac­ing. The waves were com­ing on con­tin­u­ously, and grow­ing stronger. I could not stay still. I paced upstairs; I paced down­stairs. I remem­ber bend­ing over the cab­i­net by the door as another pro­gress­ing wave over­took me.

Gus stopped me on the stairs, thrust­ing half a piece of toast into my hand. Think­ing it was a good idea, I started to eat. Then, because I was pro­gress­ing so quickly, the food turned to card­board in my mouth and I had to spit it out.

Over the next 40 min­utes Gus con­tin­ued calmly run­ning around mak­ing prepa­ra­tions, while I floated around the house. The waves were com­ing faster now, with more and more urgency, and in between them I had to keep mov­ing. Gus fed Zoe lunch, and put her in front of the TV to watch a movie. He filled the bath­tub par­tially full of water (there was not enough time to fill our birth pool), and peri­od­i­cally checked in on me.

At approx­i­mately 2:15 p.m., I felt what I thought was an urgency to clear my bow­els, which I had done before Zoe’s birth. But when I sat on the toi­let and pushed, I imme­di­ately real­ized it was a very bad idea. Pow­er­ful waves of pain over­took me, com­ing like a Mack truck— sear­ing, pierc­ing pain that alarmed and shook me. I got off the toi­let, but the waves came still more angrily, and I had to bend over and brace myself.

A few min­utes later, Gus came in to check on me, and I told him to page Chris­tine right away. The waves were pro­gress­ing quickly and I knew we needed her there. Waves like vice grips shot through my body, and I started get­ting really scared. Chris­tine was 30 min­utes away. I started to freak out. No one was there yet, and the fero­cious­ness and urgency of each wave was scar­ing me.

On all fours, I leaned over the bed, brac­ing myself for the next pierc­ing wave, softly moan­ing with it as it passed through me. That was how Gus found me. He put his hand on the small of my back and said, “Jac, are you OK?” That’s when I real­ized that I was shiv­er­ing and shud­der­ing between the waves. I couldn’t talk. I was bent over, instinc­tual, primal.

Gus intu­itively reached down under my bot­tom, and said, “My God, Jac, the baby is com­ing!” His calm state was replaced with a halted, urgent state of emer­gency. “Jac, just hold on till the mid­wives come!“
When he told me that the baby was there, it com­pletely changed my resolve. I woke up out of my fear, feel­ing tremen­dous relief that it was OK, and I could push now. With the next wave I didn’t hold back. I let it over­take me and I pushed. From behind me, Gus exclaimed, “My God, it’s his head!!!”

I was empow­ered. I knew intu­itively that it was OK. I could let the baby come out. And with the next wave I again pushed…and all in one swoosh, out came Max into Gus’ out­stretched hands.

At 2:37 p.m., about 10 min­utes later, Gus paged our mid­wife, Chris­tine, shar­ing that we had had the baby, and that mom and baby were doing well.

Our Birth Sto­ries
This was our sec­ond birth. Prior to Max, our daugh­ter Zoe had been born at home in a water birth. And fol­low­ing Max’s birth, our sec­ond son, Caleo, and our sec­ond daugh­ter, Matea, were also born at home, sim­i­lar to Max’s birth, each in under two hours. We had been blessed with four beau­ti­ful “fast” birth expe­ri­ences at home.

I’ve spent a lot of time con­tem­plat­ing what it was that gave me the faith to trust my body. What helped us carve our path, so starkly dif­fer­ent from an allo­pathic hos­pi­tal birth.

I believe the trust and faith grew from our chi­ro­prac­tic par­a­digm. My hus­band and I both have faith in our bod­ies’ innate intel­li­gence, and the uni­ver­sal intel­li­gence that placed it there. We see birth as a nat­ural, inborn process, and we wanted to have the health­i­est, gen­tlest and safest births for our chil­dren, so that they could be born at their fullest potential.

After Max’s birth, I felt the need to explore fast births. I needed to dis­cover if they are really as rare as is com­monly thought, and to hear from other women who had had sim­i­lar fast birth expe­ri­ences, to find out if there is uni­ver­sal­ity in faith and trust that helps facil­i­tate them.

Pre­cip­i­tous Labor and Birth
Max was born in approx­i­mately 70 min­utes. That’s from my first con­trac­tion until he bar­reled out into the world. Our sec­ond son Caleo’s birth took 1 hour and 25 min­utes, and our sec­ond daugh­ter Matea’s birth was approx­i­mately 1 hour and 40 minutes.

Fast labors and births such as these are called “pre­cip­i­tous.” Pre­cip­i­tous is defined as “very steep, per­pen­dic­u­lar, or over­hang­ing in rise and fall; hav­ing a very steep ascent.” Some of its syn­onyms are hasty, rash, hur­ried, helter-​skelter, drive-​by and rushed. There is often an ele­ment of sur­prise in these births, as many of us are unpre­pared for how fast the nat­ural birth process can be.

The med­ical def­i­n­i­tion of a pre­cip­i­tous birth is a labor in which the labor and birth, from first con­trac­tion to the birth of the baby, occurs in three hours or less.

Upon read­ing many women’s sto­ries of pre­cip­i­tous labor and births, I found that most of these birth sto­ries were inspi­ra­tional sto­ries of nat­ural birth, with no med­ical inter­ven­tion, that just hap­pened quickly. Beau­ti­ful births were described: gen­tle, spir­i­tual and with­out fear, where the mind and body were connected.

This is not how pre­cip­i­tous labors and births are usu­ally por­trayed in the media. Most often they are shown as emer­gen­cies, or in med­ical terms as BBA, or “birth before arrival,” mean­ing birth before arrival in hos­pi­tal. For exam­ple, there’s the cliché of the mom giv­ing birth in the car because she can’t get to the hos­pi­tal on time. As a result of the media in the West­ern world, pre­cip­i­tous labors and births are often seen as an anom­aly, unusual and rare.

The med­ical texts sup­port that pre­cip­i­tous labors and births are an anom­aly. Williams Obstet­rics, a lead­ing obstet­rics text in the U.S. and Canada, cat­e­go­rizes pre­cip­i­tous births as abnor­mal labor, or “dys­to­cia.” The abnor­mal mech­a­nism is said to be uter­ine dys­func­tion, where the uterus and abdomen con­tract with abnor­mal strength, or else there is abnor­mally low resis­tance of the soft parts of the birth canal.

This is the­ory, as no pub­lished stud­ies have tested for abnor­mal uter­ine con­trac­tions or low resis­tance in the birth canal dur­ing pre­cip­i­tous labor and births. This the­ory also con­sid­ers the cause of pre­cip­i­tous birth to be a phys­i­cal aber­ra­tion, with no con­sid­er­a­tion of the birthing mother or child’s con­scious part in the birth, nor for the innate process led by uni­ver­sal intelligence.

Instead of accept­ing that our births were “abnor­mal,” I won­dered: By what means are they defin­ing nor­mal? Are they defin­ing it in a West­ern cul­tural con­text, or cross-​culturally? And what pop­u­la­tion of women are they con­sid­er­ing — women who have not pre­vi­ously given birth (nul­li­paras) or women who have already given birth one or more times (multiparas)?

Fre­quency of Pre­cip­i­tous Labors
One way of defin­ing abnor­mal­ity is sta­tis­ti­cal devi­a­tion. So I looked into sta­tis­tics on the fre­quency that pre­cip­i­tous births occur.

There is very lit­tle pub­lished infor­ma­tion on pre­cip­i­tous labor and its fre­quency. Most resources use fig­ures from the U.S. National Vital Sta­tis­tics Report pub­lished in 2009, which says, “while exact sta­tis­tics as to the per­cent­age of women who expe­ri­ence pre­cip­i­tous labor is not known, it is esti­mated at approx­i­mately 2 per­cent of all births.” In this report, 89,047 births out of 4.3 mil­lion live births (2 per­cent) were reported as com­pli­cated by pre­cip­i­tous labor in 2006.

The data from the pre­vi­ous U.S. National Vital Sta­tis­tics Report, pub­lished in 2000, reported 79,933 births out of 3.9 mil­lion live births as com­pli­cated by pre­cip­i­tous labor in 1998, a sim­i­lar find­ing of 2 percent.

This per­cent­age seemed very low, so I researched how the sta­tis­tics were recorded. I learned that the sta­tis­tics are recorded at a state level. In the United States, state law requires birth cer­tifi­cates to be com­pleted for all births. For each birth, either the birth atten­dant, the hos­pi­tal admin­is­tra­tor or a des­ig­nated rep­re­sen­ta­tive of the facil­ity where the birth occurs is required to record and reg­is­ter the birth record.

This indi­rect record­ing of sta­tis­tics may lead to under­re­port­ing. As hos­pi­tal admin­is­tra­tors, a fast birth might not be ranked as med­ical details that need to be recorded on a sep­a­rate sec­tion of the birth record. They might not con­sider it a “med­ical labor com­pli­ca­tion,” as it is des­ig­nated in the National Vital Sta­tis­tics Report. And so many pre­cip­i­tous births may go unreported.

Another study was done to deter­mine the extent to which the accu­racy of birth cer­tifi­cate data varies by risk fac­tors and out­comes. The results showed that under­re­port­ing of birth cer­tifi­cate data ele­ments varies by mater­nal char­ac­ter­is­tics, par­tic­u­larly Eng­lish lan­guage pro­fi­ciency. The study demon­strated that it is impor­tant to con­sider sub­groups (such as eth­nic­ity and Eng­lish lan­guage pro­fi­ciency) in data qual­ity when birth cer­tifi­cate data is used.

This data is also lim­ited to the U.S. The “approx­i­mate” esti­mate of 2 per­cent does not take into account other coun­tries, where dif­fer­ent cul­tural approaches, philoso­phies and lower rates of med­ical inter­ven­tion in labor and birth would likely give dif­fer­ent statistics.

I did find an older study, con­ducted by Con­ger and Ran­dall in 1957, that exam­ined labor and births over a six-​year period at State Uni­ver­sity of Iowa Hos­pi­tals. It found an inci­dence of 10.2 per­cent pre­cip­i­tous labors.

Stud­ies also show that the chances of pre­cip­i­tous labor increase for women who had given birth pre­vi­ously one or more times (mul­ti­paras). In one study, 99 births were iden­ti­fied from 1990 Bronx Munic­i­pal Hos­pi­tal Center’s birth records as short labor, equal to or less than 3 hours in length. Of the 99 births, they found that 93 per­cent occurred in multiparas.

Con­ger and Randall’s 1957 study also found that women who had expe­ri­enced prior pre­cip­i­tous labor were also more likely to have a repeated fast labor. They found that 40 per­cent of the 731 women with pre­cip­i­tous labors had a his­tory of a past labor of three hours or less.

If there is an increased like­li­hood for pre­cip­i­tous labor in mul­ti­paras and women who have expe­ri­enced prior fast labors, then these sta­tis­tics need to also be con­sid­ered when esti­mat­ing the rate of pre­cip­i­tous births.

It is evi­dent that fur­ther stud­ies need to be con­ducted, cross-​culturally, with bet­ter means of record­ing, and they need to include women who have given birth pre­vi­ously, in order to deter­mine the fre­quency of fast births of less than 3 hours in dura­tion. The results should show a much higher fre­quency than the com­monly pub­lished esti­mate of 2 percent.

Facil­i­tat­ing a Pre­cip­i­tous Labor
Most pub­lished lit­er­a­ture lists the deter­mi­nants for a pre­cip­i­tous labor as phys­i­cal — most com­monly, the expla­na­tion given in Williams Obstet­rics, list­ing the causes as an extremely effi­cient uterus that con­tracts with abnor­mal strength, or extremely unre­sist­ing soft tis­sues in the birth canal. Other pos­si­ble phys­i­cal and genetic deter­mi­nants are dis­cussed anec­do­tally, and include the fol­low­ing: a larger than aver­age pelvic out­let; a well lined-​up pelvis, pubic bone and birth canal; a smaller than aver­age size baby; a baby who is well-​positioned for descent; or a grand­mother, mother or sis­ter who also had pre­cip­i­tous labors.

Chi­ro­prac­tic helps with some of these phys­i­cal deter­mi­nants, such as help­ing to line up the pelvis and spine to help max­i­mize the shape and size of the pelvic out­let for the baby’s descent. Chi­ro­prac­tic can also help reduce in-​utero con­straint to the baby, through the Web­ster tech­nique, help­ing facil­i­tate a health­ier posi­tion for the baby for descent.

How­ever, although these phys­i­cal deter­mi­nants may help in a pre­cip­i­tous labor and birth, they are only one com­po­nent in the birth process. A birthing mom requires a cer­tain men­tal, emo­tional, instinc­tual and spir­i­tual state for birth, espe­cially a fast birth.

Pre­cip­i­tous births can elicit tremen­dous fear in birthing moms, with the fast climb in inten­sity of con­trac­tions and the rapidly dimin­ish­ing space between them. If a birthing mother suc­cumbs to her fears, the birth process can be slowed or halted.

When our first­born, Zoe, was born, there was a strong men­tal and emo­tional com­po­nent. I learned to “let go” and sur­ren­der. My biggest fear dur­ing the waves and rushes of labor con­trac­tions was the fear of the unknown. If this cur­rent wave was that painful, I thought, what would the next be like, and how could I han­dle it as they increased in inten­sity and dura­tion, and how long would I be able to carry on? My men­tal state was dri­ving my emo­tional state, and ulti­mately dri­ving my phys­i­cal state. As I detached from the emo­tional fears, and men­tally let go, the nat­ural process was allowed to unfold. By let­ting go, I was sur­ren­der­ing, and giv­ing up con­trol, allow­ing the innate birth process to open up my body.

Max’s birth was a rac­ingly instinc­tual birth. There was very lit­tle men­tal com­po­nent; there wasn’t time to think about sur­ren­der­ing. I learned to “give way” to birth. It was like a fast-​moving truck was plow­ing through me, and I had to give way and let it hap­pen. It was raw and all-​consuming, with instinct dri­ving the invol­un­tary process of birth. It was more con­sciously uncon­scious, dri­ven by the hindbrain.

Caleo’s birth was a more spir­i­tual expe­ri­ence. I got to a place where I was con­sciously con­nected with a higher power. Through­out the birth my mind was clear. I had no hes­i­ta­tion or fear. There was just a clear com­mu­ni­ca­tion with God to move into each wave, and let each wave do what it needed to do. When I fully opened up to the inten­sity there was no pain.

In Matea’s birth, there were all com­po­nents— men­tal, emo­tional, instinc­tual, spir­i­tual and phys­i­cal. I was com­pletely focused within, present with each thought, mov­ing instinc­tively as my body told me to, stand­ing and mov­ing my hips in wide cir­cles, unin­hib­ited, con­nected with our higher power and the innate wis­dom of my body and Matea’s mov­ing down the birth canal. Again, there was no pain.
When I explored the pre­cip­i­tous birth sto­ries of other women, they shared sim­i­lar expe­ri­ences. The com­mon­al­ity seemed to be the appli­ca­tion of “let­ting go,” or sur­ren­der­ing and trust­ing in the nat­ural, inborn wis­dom of the body dur­ing birth.

Through this process of explo­ration, uncov­er­ing what remark­ably lit­tle pub­lished lit­er­a­ture there is on pre­cip­i­tous labor and births, I learned that what has been writ­ten needs to be rede­fined. It is not abnor­mal for a birth to progress quickly. The fre­quency at which they occur may range from 2 to 10 per­cent of births, but fur­ther stud­ies are needed, espe­cially stud­ies that exam­ine how often they occur in mul­ti­parous women, in which the per­cent­age will likely be much higher. Also, in past stud­ies, only phys­i­cal deter­mi­nants for pre­cip­i­tous labor have been pro­posed. Instead, the com­bined phys­i­cal, men­tal, emo­tional, instinc­tual and spir­i­tual state of birthing moth­ers needs to be studied.

In redefin­ing pre­cip­i­tous labor and births, we may open up the pos­si­bil­ity that these labors and births are nat­ural, nor­mal and healthy…and that they may not be rare, but may occur a lot more fre­quently than we real­ize. And in study­ing what deter­mines a fast labor and birth, we may be able to find out if the faith and trust that women have in their body’s inborn wis­dom in birth is what facil­i­tates them.

Jacque­line Tsi­a­palis, D.C., FICPA

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