What to do when in labor: Your Guide to VBAC Labor

No matter how much preparation I did for my two VBA2C labors, I remember getting to this point with each of them where I felt like “what do I do now?!” Even as a doula who thought I should have known all the answers, I always felt this sense of confusion or panic when I went past my due date or had something atypical happen during labor.

This is such a common feeling. We want there to be a formula, an equation, an exact science that tells us what’s going to happen during labor, how exactly to navigate it and what the outcome will be.

But that’s not how labor or birth or babies work. It’s that guesswork that makes things, yes, a bit frustrating, but also… so worth it.

In an effort to help you feel like you have a guide for troubleshooting some of those “what do I do now” moments, we’ve put together your very own VBAC Labor Guide. We hope you find it helpful.

What to do when…

You go past your due date
In early labor
Early labor is long
Labor becomes more painful than you expected
Your water breaks but contractions don’t follow
You have back labor
Pushing is long
Your provider says you are “failing to progress”
Things don’t go as planned

You go past your due date

I know getting close to and passing your “due date” can feel frustrating. Everyone around you is wondering and asking, your provider might be putting pressure on you to induce and you might just feel so ready to meet your baby. It can be tough mentally and physically, especially if you have been made to feel like you should have already had your baby.

Let me reassure you… in most cases, you can breathe easy, this is normal. Many “due dates” are incorrect in the first place, and your baby knows when to be born. You can read more about the risks associated with going past your due date in our article VBAC After 40 Weeks, but for now, here are my favorite tips for spending your time when you go past your due date:

Stay distracted – Sitting around and waiting for that babe to come can certainly make it feel like time is barely ticking by. Keep yourself busy (obviously don’t overdo it) by continuing to work or maintaining a regular daily routine.
Invest in yourself – Use this “extra” time for extra self-care. Get a massage, get your nails done, take long walks and long baths, journal, watch something that makes you laugh and spend extra time with your partner. You deserve to feel loved and relaxed right now.
Practice affirmations – Be sure to fill your mind with confidence and positivity. Fill your home with affirmations and rehearse them often.
Plan ahead – This is a great time to think about postpartum, a time when you’re really going to need some extra support. Stock your freezer with a couple of meals and snacks (we love this cookbook), stage your postpartum supplies, organize a couple diaper/nursing stations, and think about who will do daily tasks around the house after your baby arrives (grab a couple notepads for the fridge to make planning and delegating even easier).

You’re in early labor

You’ve noticed a couple of twinges, cramps or different feelings. You’re kind of hesitant to call them contractions, but there have been a few of them in a row. OMG, could it really be happening?!

That moment you realize that you might actually be in labor is so exciting! There are probably so many endorphins running through your body and thoughts running through your head, it can be hard to think clearly at all. Here’s the most important thing…

REST UNTIL YOU RESTING IS NO LONGER AN OPTION.

This is not a sprint, my friend. This labor may be a marathon, and you don’t need to beat anyone to the finish line. Rather than trying to chase labor, REST. If this is truly labor, it’s not going anywhere. Here are the things you should prioritize while you can in early labor…

Notify your doula – I tell every one of my clients that there is no such thing as too much information! Even if it’s just a quick text, your doula wants to know if you think there’s even the slightest possibility that labor is near. Just shoot them a quick message, and then move on to step two. 🙂
Sleep – If it’s the middle of the night, go back to sleep if you can. If it’s the middle of the day, try taking a nap.
Nourish – Early labor is the best time to eat a good meal because this may be the last time you’re actually hungry + you need fuel for the events ahead. Think protein, whole grain carbs and healthy fats that are easy to digest (eggs, smoothie & oatmeal with nut butter).
Shower – A shower helps you feel like yourself and feel ready for the day ahead. Showering can also help you feel more calm and relaxed.
Distract – This isn’t the time to start timing every contraction, this is the time to keep yourself distracted with anything that makes you feel good. If you have a few more things to check off your to-do list, set a 30-minute timer and get done what you can. Then move on. Maybe you want to play a game with your older kiddos, binge a couple episodes of your favorite show or fold some baby clothes. When I was in early labor, I sent my husband to Target with our older two and stayed home to color pictures and write notes they could read when I’d be at the hospital. It was the perfect relaxing, distracting activity.
Rest – And because it’s just so important, I repeat: REST. So many times I hear my doula clients say (after their birth), “I probably should have just rested more in the beginning.” Take a nap, put your feet up and grab a snack, catch up on episodes of your favorite podcast (like The VBAC Link Podcast), watch a movie or grab a good book.
Miles Circuit – And if you know you should be resting, but it just feels much too “underproductive,” try the Miles Circuit. It’s a great sequence of restful positions that help get baby aligned and will help you feel like you’re doing something to move labor along.

If your water has broken during this early labor stage, take note of how you’re feeling, the color of the fluid and confirm there is no cord. Consider putting on a pad and going back to sleep. More on “what to do if your water breaks” below.

Early labor is long

Yes, early labor can be long. It’s normal for it to last several hours or maybe even days. In general, if your contraction pattern is somewhat consistent, and those contractions are getting longer and stronger, you’re in labor (read more on navigating prodromal labor here).

It’s perfectly normal to just need time. Here are a few things to do if labor is taking longer than you’d like…

Prioritize all of the things listed above (rest, nourish, shower, distract and rest some more)
Make sure you’re in the right mindset. There is most definitely a connection between how we’re feeling mentally and how our body will progress in labor. Take this time to journal, meditate, reaffirm your birthing desires or do a fear release activity (ideally, you’ve done this before labor begins, but better late than never!).
Try a different position. There could be a physical component to your long labor, so consider trying some intentional movements that help baby get aligned like the Miles Circuit or the Spinning Babies Daily Activities.

Labor becomes more painful than expected

Now, there is a difference between accepting a long early labor and enduring a painful labor. I get it. This is often where thoughts creep in like “This is going to end up exactly like last time” or “I’m never going to be able to do this the whole time!”

Hear me, dear woman of strength… you can do this. You ARE doing this. And this is a different pregnancy, a different baby and a totally different birth than any you have had before.

When rest is no longer an option in labor, it’s time to move. Movement has the power to distract your mind and alleviate pain. Here are some great options to help you cope with painful early labor…

Enlist the support of your partner and/or doula – This is the perfect time to have your birth team join you or at least support you virtually. Their words of encouragement and reaffirmation of your strength could be just what you need right now. Plus, applying some counterpressure/hip squeezes, being there to sway with you or suggesting different movements can be extremely helpful.
Move during contractions – Rock, sway, squat, lunge, sit on or lean over a birth ball. All of these are great options for coping with pain and helping your baby align and descend. Your doula will have some great suggestions, but ideally you’re changing positions every three to five contractions.
Just add water – A shower or bath, pointing a showerhead on your back or abdomen, these things can truly help you feel weightless, distracted and comforted enough to get you to the next phase of labor.
Consider other forms of pain relief – Based on where you’re giving birth and what you’re comfortable with, there are some forms of pain management to be aware of like a TENS Unit, nitrous oxide, sterile water injections, analgesics or an epidural. It’s really important you know that never, ever is it wrong or a failure to choose pain relief if you need it and decide that it’s right for you.

Your water breaks but contractions don’t follow

It isn’t all that common, but it does happen. Premature rupture of membranes (PROM), occurs in less than 10% of labors and essentially means that your water breaks before labor (contractions) begin. In most cases, labor will start on its own within 24 hours, so while it’s not an emergency situation, here are a couple of things you should know and do…

Confirm that it’s your water – If it’s just a trickling, you may wonder if you had a little accident (not uncommon in pregnancy!). Put on a pad to help you determine if there is a constant trickling.
Note TACO – Pay special attention to the time your water broke, the amount, color and odor of the fluid.
Notify your birth team – Both your doula and your provider will want to know that your water broke, even if it’s just trickling.
Rest – Again, unless you feel otherwise, this isn’t an emergency, and this isn’t a time to chase labor. Rest, nourish, shower and take your time. Labor will start soon!
Avoid putting anything in the vaginal canal – Your baby’s secure home is now a little less secure, so avoid exposure to unnecessary bacteria by not having intercourse and considering declining cervical exams. Also, try to stay home, as anywhere you go will potentially introduce new types of bacteria to your baby.
Know when to seek medical attention – Call your provider immediately or go to your birthplace if you are less than 37 weeks, you develop a fever, your fluid is green/yellow or smelling bad, your baby is moving less than usual or you experience heavy bleeding.

For more information on PROM, check out these helpful resources What to do When Your Water Breaks, Evidence on: Premature Rupture of Membranes and When your water breaks before labour (worksheet).

Based on your unique situation (especially if you are GBS positive), your provider may have specific recommendations for what to do and when if you experience PROM. Listen to your intuition, ask questions and make an informed decision based on your personal assessment of risk.

You have back labor

It’s quite common for mamas to experience back labor that just won’t quit, and it can often be the reason they decide to have an epidural. Spinning Babies tells us that back labor is often due to “tight ligaments, tight or weak muscles or the baby’s position.” Here are some tips for coping with back labor…

Ask your partner to apply counterpressure (Mamastefit does a great breakdown of counter pressure techniques)
Try the Spinning Babies Abdominal (Belly) Lift or Forward-leaning Inversion
Use heat compress like a heating pad, showerhead aimed at your lower back or warm wash clothes
Consider a TENS Unit or sterile water injections
Try to change movement every 3-5 contractions, even if movements are subtle

Pushing is long

You made it! Whether it was a long or short labor, you’re in the homestretch now, mama! Although pushing sometimes feels scary (especially for VBAC moms who have never experienced it with their first babe), it also can feel like a relief, like you’re getting a tangible return on all of that hard contraction work you’re doing.

While the pushing stage can take anywhere from a few minutes to a few hours, here are a couple things to consider if pushing is taking longer than expected…

Laboring down – This is really something to be aware of BEFORE you start pushing, but it doesn’t get talked about nearly enough. Laboring down is the idea that even though you may be at 10cm with a completely softened cervix, you may not have the urge to push yet. Baby may need a bit of time to completely descend. Don’t get worried if the urge to push doesn’t arrive as soon as you’re complete. It’s ok to take some time, get in a comfortable position and… wait just a little longer.
Change positions – Pushing doesn’t have to be done on your back, in fact, there are so many really efficient ways to push like sitting on the toilet, using the squat bar or side-lying. Check out some of our favorite pushing positions here.
Breathe – Reconsider your breathing technique. Have your doula, partner or midwife suggest a new breathing pattern.
Nourish – You might just need a boost of energy. It could be some electrolytes or a honey stick or it might be something more substantial like a pb&j or a couple protein balls.
Rest – I know the last thing you might want to do is rest (again), but it might be exactly what you and your baby need. It’s ok to let the room get quiet again, go internal and rest for a bit longer.

If this second stage truly does extend itself, you may really rely on the support of your birth team. Extra words of encouragement from your partner and doula as well as expertise of your provider will be lifesavers.

Your provider says you are “failing to progress”

Many (too many) mamas were told they had to have a c-section because of a “failure to progress.” We believe that in most cases, it was a “failure to wait.” Again, we know that for one reason or another, labor takes time. It could just be that your body and your baby need time, or it could be another reason like baby’s position, an environmental issue, mama’s need for rest or something else.

Sometimes you’ll hear “failure to progress,” or sometimes you might hear something else, like…

Baby isn’t engaged – Check out these tips from Spinning Babies
Labor is stalled – Try changing positions frequently and emptying your bladder
You have a swollen cervix – Try rest, quieting your environment, a warm bath, the knee-chest position or another positional change to encourage baby to rotate

We could never possibly know all there is to know about your unique birth situation, and we never want to claim quick fixes. While many labor challenges can be navigated with time and support, there are certainly situations that require more medical attention. If you feel like something isn’t right, you need extra support or have a challenge greater than what we’re discussing here, please be sure to discuss options with your provider.

Things don’t go as planned

Last but certainly not least, I want to address one more thing… what if despite all the work you do to have your VBAC, things just don’t go as you planned? Maybe you end up having a repeat c-section (RCS), you get an epidural when you originally planned to go unmedicated or something else happens throughout the course of your labor that just isn’t what you wanted.

I’ve been there. So, so many of us have.

In those moments during and the weeks following, I hope you’ll hear this – YOU ARE STRONG. Your body didn’t fail you, you didn’t do anything wrong and your birth outcome doesn’t make you any less of a mother. You deserve the time and space to process every twist and turn of your birth experience because… it matters. You matter, mama.

As always, my strong friend, I will leave you with this affirmation and reminder…

We’re so grateful to be on this journey with you!

Don’t forget to join our Facebook community, follow-us on Instagram, check out our Parents VBAC and HBAC Education course and give our podcast a listen where lots of incredible women share their VBAC journeys.