Intro

 When it comes to birth, the only thing we can really be sure of is to expect the unexpected.

Birth plans are wonderful and important for working out what you would like to try for, where your comfort level is, ensuring your team and providers are aligned and supportive, and as a roadmap for birth partners to advocate for you.

However, as anyone who has given birth will tell you, there are parts of the experience that end up beyond the plan. That doesn’t mean that unexpected things that arise are always negative; they are just different. So, in the spirit of being compassionate truth-tellers, something that is at the core of all we do at Needed, we are launching our series of birth stories, covering a vast spectrum of birthing experiences but all celebrating positive outcomes even while sometimes dealing with complicated circumstances, with the idea that knowledge is power and the more you know, the less you might be blindsided by your own birth story.

Zero to Sixty my Birth Story by Paula James Martinez

As Editorial Director at Needed, I’m actually starting the series with my own birth story. Mostly because every time I told my peers how it went down, the answer was “That's crazy?!”

My birthing experience changed my life. Obviously, most people’s births do.

Mine also shifted my career out of fashion and into film and women's health. I actually ended up making a feature-length documentary and starting a maternal health non-profit! All because of my experiences during my pregnancy and birth.

I was very well prepared for birth, more so than many people have the privilege of being.

I had a career as an editor in women's magazines, and so research was quite second nature to me. I also grew up in the UK. In the UK midwifery is standard, and a lot of the conversations around birth are different - I think it probably made me a little less fearful of the process. Stiff upper lip and all.

I also felt empowered to ask for what I wanted. And after feeling uncomfortable with my OBGYN and with support of my partner and help from my Doula, I was able to switch to midwife care at 34 weeks; I was lucky enough to feel really comfortable with my team and providers, and felt good about my needs being heard when labor arrived.

I did hypnobirth classes, yoga, and chiropractic alignment, and I took my supplements.

I understood the c-section process and when it might be needed. Also, why I wanted to try for unmedicated birth and how those long hours of labor pains could potentially be managed through water, movement, and breath. I ordered Nitrous Oxide for the birthing center, which is standard in British birth. I’d even prepped my postpartum. I thought I was ready for anything.

Then at about 38 weeks pregnant, I went to the farmers market, and honestly, I was grumpy, erratically moody even for a very pregnant person, but I didn’t feel anything else. We went home. I had a really early dinner and looked longingly at the full moon out the window, imagining that my daughter, who I’d already chosen to be called Luna, was connected to it somehow? I went to bed, and I went to sleep.

At around 12 pm, I woke up to find the bed soaked - obviously my first reaction was pee? But I went to the bathroom, and there was a lot of water, and I realized it must have been my water breaking, but I had no contractions. I woke up my husband at around 1:30. I was starting to feel a little weird, a little twingy, by 1:45 the twinges actually started to feel quite intense. I told my husband to call the midwife; she asked us to start timing them in a contraction app she suggested. They were around 2 to 3 minutes apart.

She told us to relax; labor would be long, but to go ahead and come in if we felt we needed to. I felt we needed to; in fact, the contractions felt super intense, and I was starting to feel like I had made poor life choices if the very start of my contractions were feeling this strong; maybe I was too much of a wimp.

We got in the car and drove the 30 minutes, as thankfully it was the middle of the night, across LA. I was super uncomfortable, my contractions were strong, but I turned on NPR and tried to focus on a conversation about local politics and catch my breath, remember my breathing.

By 2:15, we were there, walked in - they checked my heart rate, and I was apparently progressing well. My doula had arrived, and I got in the tub, I started to relax and regulate my breath. I was very, very quiet. But soon apparently my baby's heart rate was high, they thought I was likely too hot, so I got out of the tub and rested on the bedside with my doula. The midwife brought my pre-ordered “gas and air”.

I felt ok, our heart rates went down, I actually thanked everyone for coming, my husband popped to the car, the midwife went out of the room for a moment to get a chart. My doula Emma held my hand and told me it was just us, to just relax. I relaxed, I also pushed, in my quiet internal place I knew I was pushing, but I don’t think I communicated it. It was only when I said "I don’t think I can do this" my doula noticed my daughter was in fact crowning and started yelling for the midwife, who ran back in, just as my doula Emma caught her as she coming out. Much to all of our surprise!

My husband missed the entire event; when my doula Emma knocked on the window to let him know the baby was here, it was just after 3 am. My entire labor experience had taken less time than my average dinner reservation with dessert.

I was utterly shell shocked but we were all fine. I did, however, due to the fast labor, have a retained placenta, in so much as it took a long time and that needed both a largely uncomfortable massage and a shot to induce further uterine contractions to help that process. After all the checks, however, both the baby and I were deemed to be doing well. I had two cups of tea, and by 10 am we were all home again together eating breakfast burritos with a newborn.

Follow-up midwives visited me at home in the coming days, and checked on progress. All commenting on what a "wild but wonderful experience" I had, had when they checked my notes. And I think I told them all I was wonderful, I was so lucky.

It was only in the coming weeks did I start to unpack what had actually happened. That what my birth story was, is precipitous labor. And although it sounds like a dream, I actually had some complicated feelings about how fast everything had gone, how I didn’t feel like I had time to transition, how I’d hung on to the roller coaster but was maybe now a little freaked out by it all.

People said I’d had a unicorn birth; the unicorn nature was something I was trying to understand and it led me to some of the data around birth in the US that informed the start of my documentary “Born Free”. Was I too lucky? Why was I lucky? Why don’t we fully understand what causes labor to start? Why do so many women have an “average” length of labor but also not have great experiences? How could I fix it?

I also felt a bit like I couldn’t complain, my postpartum recovery wasn’t super fast, I bled a lot, and for a long time, which I later learned is common in precipitous birth, I felt battered, I’d needed quite a lot of stitches, breastfeeding was hard and I had a lot of postpartum anxiety. But I felt like I couldn’t complain that I'd had this super easy “Unicorn Birth”.

It was an interesting thing to grapple with, and I’m certainly not asking for tiny violins but more wanting to share that this is a thing, sometimes really fast labor happens, there is not a lot of research as to why? Everyone had told me the process would be long. I’d prepared for long. My husband had even proudly made a lentil soup ready for the potential day or so at the birth center. No one knows what kind of birth story they will get; I guess mine was just very short.

Some Needed Facts about Precipitous Labor

Precipitous labor, also known as rapid labor, is characterized by its swift and condensed duration. It occurs when a baby is born within three hours of the onset of regular contractions, a stark contrast to the typical labor duration ranging from six to 18 hours. While the prospect of a rapid labor may seem appealing compared to prolonged childbirth, it poses risks to both the birthing parent and the baby.

How Fast is Precipitous Labor?

Precipitous labor is defined by the arrival of the baby within three hours of the commencement of regular contractions, although some healthcare providers extend this threshold to anything less than five hours.

Signs and Symptoms of Precipitous Labor

The symptoms of rapid labor can vary but often include:

• Sudden and closely spaced contractions from the outset, without the typical breaks observed in regular labor.
• Intensely painful contractions with minimal build-up in intensity.
• An urge to push, sometimes likened to the sensation of needing to have a bowel movement.

Causes and Risk Factors

The exact cause of precipitous labor remains uncertain, but certain factors may heighten the likelihood, including:

• Previous childbirth experiences.
• Baby's smaller size.
• Exceptionally strong uterine contractions.
• Soft and flexible birth canal.
• High blood pressure.
• Induction with prostaglandins 

Complications of Precipitous Labor

The unplanned nature of rapid labor can lead to a loss of control, presenting challenges both physically and emotionally. Complications may include:

• Heavy bleeding or postpartum hemorrhage.
• Shock due to inadequate blood and oxygen supply.
• Increased risk of perineal tears and vaginal lacerations.
• Retained placenta or difficulties in its expulsion.
• Delivery in unsterilized environments, potentially leading to infections.
• Emotional distress for the birthing parent.
• Risks for the baby such as meconium aspiration or infections.

Managing the Pain and Coping Strategies

While precipitous labor may be more painful due to various factors such as the inability to receive pain medication in time, coping strategies include:

• Contacting healthcare providers promptly.
• Practicing relaxation techniques and deep breathing.
• Ensuring companionship and cleanliness.
• Adopting a left-side lying position.

Preparation and Induction

Preparation for rapid labor involves having hospital bags packed well in advance, containing essentials for an emergency delivery. In cases of extreme risk, early induction might be considered, though it comes with its own set of risks that should be discussed with healthcare providers.

Prevalence of Precipitous Labor

Studies suggest that precipitous labor occurs in approximately 3% of all births, often associated with preterm deliveries.
Understanding precipitous labor is essential for expectant parents and healthcare providers alike, enabling prompt recognition and appropriate management of this uncommon childbirth scenario.