As active doulas, it seems that sometimes we get a few of labors in a row with similarities, and our most recent bunch of births have had contraction patterns that can be described as back-to-back. Read on for our take on what this looks like, what this means, and what to do about it.
What's normal, anyway?
What is normal, anyway? Can we really reduce labor and birth down to a set of rules or even guidelines to expect? Having been to hundreds of labors, we can pretty surely say no to that one. Some labors are 3 hours or less; some are 30 hours or more. Some have contraction patterns which steadily increase over time, meaning the contractions get longer and stronger and closer together with relative predictability. But some start out fast and strong, then dwindle. Or some seem to take off out of nowhere. Some require medical support to get started. There are literally hundreds of variations of how labor can begin and progress.
The most straightforward of by-the-book labors include early labor contractions which last around 45 seconds and have many minutes in between contractions. Active labor is described as contractions lasting around 60 seconds with around 3-5 minutes between the start of one contraction to the start of the next contraction. Transition includes contractions lasting around 90 seconds with only 1-2 minutes between the start times of contractions.
Today, we want to discuss contractions that are "back-to-back". What this might look like are contractions that begin, peak, and end or nearly end, only to start right back up, peak and end again. The break that birthing parents are "promised" between contractions may not actually happen. This can be really difficult to cope with mentally; we are given the expectation that there is a certain amount of time between our contractions. When this doesn't happen, we can feel lied to, we can feel overwhelmed at the unexpected intensity of our contractions, and we sometimes even feel embarrassed that we didn't know beforehand that these back to back contractions were a possibility.
Sometimes contractions are back-to-back, or otherwise described as "coupling." They may also be referred to as "double-peaking" contractions. Your medical provider (your midwife or obstetrician) has the responsibility to look out for uterine tone, reassuring fetal heart tones and more. We want to focus on your tasks as the laboring parents. Some of your tasks as the laboring parent are to get busy relaxing to promote oxytocin flow to encourage labor's progression, and sometimes, repositioning baby through optimal maternal positioning.
Sometimes, coupling contractions are a sign of baby being sunny side up, or Occiput Posterior (OP). Sometimes, with an OP baby, the journey through the pelvis can be slower than anticipated. The uterus is powerful, and uses double-peaking contractions to reposition baby. Strong uterine contractions can help the baby to rotate during labor, to a more favorable anterior position.
What should I do?
The uterus is a powerful organ and sometimes even doing nothing can result in baby rotating during labor and contraction patterns becoming more normalized. We recommend spending as much time as possible OFF of your back and tailbone and starting to think about bringing the back of baby's head forward with the assistance of simple gravity.
More often, we find that some proactive work to reposition baby can be helpful to normalize contraction patterns. You want baby's back to swing towards the front of the birther's belly, which helps encourage an anterior positioned baby. This might look like plenty of hands and knees positions, either on the bed or on the floor; doing some inversions to loosen the strong round ligaments that can sometimes impede baby's ability to rotate; and looking to Spinning Babies resources such as the Side-Lying Release to bring balance to the pelvis and optimize baby's opportunity to rotate to an anterior position. (Forever grateful to Spinning Babies' founder Gail Tully for her amazing work and training; you can read much more about baby positioning on the Spinning Babies website).
The good news is, these are all things that can be done in real-time during labor even in the middle of an unusual contraction pattern. Of course, there are no guarantees. But these suggestions can give you a great starting point. At this point in your labor you want to rely on your birth team's knowledge and trust that you've already done the hard work of hiring your birth team to help you in situations like this. As we always say, you don't need a doula until you NEED a doula! (Even those with amazing support often don't discover until mid-labor that they could use the expertise of a doula for many various reasons, just one being double-peaking contractions).
And please, rest assured; some research even points to a decreased incidence of cesarean delivery in labors with double-peaking contractions (but this is not always the case). And in those cases which do lead to cesarean, you can prepare well in advance both physically and emotionally for a belly birth with a quality childbirth class that aims to prepare parents for any labor outcome.
We suggest you begin working well in advance on baby's position (and even this does not always guarantee an optimally-positioned baby). You can influence how your labor unfolds but you cannot control it. Be sure you have adequate support lined up such as a well-trusted doula for ANY labor that comes your way, even an OP baby with back-to-back contractions.
In conclusion, back-to-back contractions can be common but they usually are not desired due to the increased intensity for the laboring person as well as a sign that baby may not be in the most optimal position for a smooth delivery. There are many things you can do to prevent positioning problems even in the throes of labor. Be sure to check in with your specific birth team who knows your background and medical history to determine the best course of action for you.
authored by Christine Ghali BA, CD, CBE
Christine Ghali is the owner of Mindful Birth Services and Doula Care and has been practicing as a professional doula since 2009. She has attended over 100 births and now runs a successful doula agency in SWFL. She enjoys teaching Birthing From Within childbirth education classes and connecting with amazing parents like you! Check out her recently published labor guides on the Mindful Birth website: The Minimalist's Guide to Having a Mindful Epidural and The Minimalist's Guide to Having a Mindful Induction