#24 Laboring Down

A hot topic that’s constantly in my DMs is can you share the research on laboring down? I’ve had a provider say to immediately start pushing when our patient is 10 centimeters, and they don’t want me to labor down. They’ll share their concerns, because as nurses, we anecdotally are like, “Laboring down saves everyone time, right? No one wants to push for more than three, four hours.”

For sure.

So we wanted to talk a little bit today on the research behind laboring down or not laboring down, and then our tips and strategies along the way of what we think our opinion is and then what we do in practice.

If you don’t know what laboring down is, let’s explain it for a second. There are four stages of labor. The first stage is before the patient is 10 centimeters, they’re in that first stage of labor. Once they get to 10 centimeters, that becomes second stage of labor, and they’re in second stage until 10 centimeters to when baby delivers. Once baby delivers, they are in third stage, and they’re in third stage from delivery of baby to delivery of placenta. Then once that placenta delivers, they are now in the fourth stage of labor.

So, where does laboring down fit? That fits in that second stage of labor. So once they’re 10 centimeters to delivery, you in theory could labor them down, so you’re not pushing right away when they get to 10 centimeters. We know that there are lots of times where they’re 10, 100, minus two, however you say that. You might say fully, you say complete, whatever, depending on where you are in the country. They are 10 centimeters, 100% complete, but sometimes they can be minus two, minus one, zero station, and sometimes the practice has been to labor them down.

Back in the day, patients used to just push, right? They felt the urge to push. That’s the Ferguson reflex, which I’m going to have Sarah explain in a second, but they felt this urge to push and they would have their baby. But in the 1980s, epidurals became really popular and we lost that urge to push sometimes.

But laboring down is when they become complete, they’re 10 centimeters, but baby’s still a little high or they feel no urge to push, or you do a practice push with them and the baby does not move at all. The idea would be, “Okay, so we’re going to labor you down or we’re going to promote passive dissent of baby.” The contractions are going to do the work, baby’s going to do the cardinal movements and come into the pelvis. So there’s passive dissent, delayed pushing, or laboring down, that’s all the same thing.

So, what does the research show? There are a few studies that say that laboring down is the worst thing you can do, it’s very much anti-laboring down, and then there’s studies that say that laboring down’s fine. The studies that show that laboring down should not be done are ones that say and show that your patient has an increased risk for hemorrhage.

There was a study with 2300 people and we will post these, that went for hemorrhage risk from 2.3% to 4.1%, so almost double of your increased risk for hemorrhage. Honestly, that makes sense to me, especially the way you labor down. If you have pit going, if you’ve labored them down for three hours, if they’ve had a 30-hour induction, they have chorio now, they’re on magnesium, a lot of factors can play into that risk of hemorrhage.

If you want more information on hemorrhage, we do have an episode on that, but there’s a lot of factors that go into risk for hemorrhage. I don’t think it’s just laboring down, but that makes sense to me in my brain that we could have an increased risk for hemorrhage with laboring down.

How does it make sense in your brain?

Why does that make sense to you? Because I think the practice at my current hospital is they can labor down for hours, based on provider availability, because we have the providers in clinic all day. So I’ve seen hemorrhages from laboring down, and so I think it makes sense. So, I think that you have to labor down-

Why do you do think the patho is that it causes a hemorrhage?

Because I think the uterus is tired. We’ve given so much pit and all the receptors are so full, and so when they deliver, it’s like, “All right, I’m done.” The baby’s out and the uterine tone is crappy, right? Once that atony can occur.

Interesting.

Then there’s a risk for chorio. There’s a higher risk for chorio, when it comes to laboring down, and I think that has more to do with how long they’ve been in labor, ruptured-

Number of vaginal exams.

Number of vaginal exams, how many times are you checking them, especially later in labor. So, then they say that there’s not much data comparing vaginal birth versus cesarean births. That’s kind of a wash, based on if you immediately push or delay pushing.

Then I went into the Cochrane review, because as you know, Cochrane, if you don’t know, Cochrane likes to do analysis of all the studies for us. They’re amazing. And they compiled 21 different studies in total. I really liked what they said, because it’s kind of where I stand too, is that, “There is no evidence to support any specific style, and that it’s patient-specific.”

They did note that, yeah, there is some evidence of more hemorrhage and chorio, and there’s some evidence of lacerations if you labor down, but the data was not good. They actually downgraded some of the data due to the study limitations, and they say that, “All of the evidence based on labor breakdown is either moderate to very low quality of evidence.”

So what that tells me is that, yeah, it’s kind of provider preference. If you have residents or providers that are so passionate about not laboring down, in my mind it kind of gives me some grace, because I’m like, “They’ve read research, they want to do what’s best. They want to get those babies out.” But it’s kind of a wash in my mind. What do you think, Sarah?

I mean, how much of this is looking at maternal satisfaction, maternal trauma, psychological trauma and length of pushing?

For sure, so the length of pushing I do know, and I did put in my notes, I was like, where is how the patients feel? Where is that?

Right.

No one talks about that, and so that’s very frustrating.

Or puts value on that. I think especially, you read a Cochrane review, I know you sent me an Instagram post this week of what did you call the type of data that’s not evidence-based data? It’s interpersonal data or something. There’s a whole thing happening on TikTok/Instagram right now about that the evidence matters, but actually our experience matters more, and this shift into a land of valuing each other’s experience.

Now mind you, some of that is subjective, some of that we’re not the most trauma informed as a community, and so to be able to check yourself before you wreck the situation, I think is a risk of that. But I do agree, and we talk about all the time, and why we have a podcast even talking about a lot of this evidence is the evidence can only show so much. Or even I was prepping for Cancun, I’ve been prepping for Cancun for a year and a half, but I was looking up some data on something, I can’t remember, maybe fascia, maybe breathing, maybe something else really fun that we’re going to do in Cancun, and feel free to come. There was this really amazing study and it was from 2012, and I was like, “It’s disregarded.”

You can’t use it, right.

I can’t use it. Which is silly, because once something’s been proven-

It’s really silly.

… they’re not going to spend money on research. Research costs money, and there are people funding research studies and there’s always an ulterior motive. Even for us, we’re talking about doing research with our stuff, and our motive is to prove that everything we teach actually helps promote vaginal birth, and reduces trauma and increases provider satisfaction.

While that is probably still true, we know anecdotally that that’s true. Until we have evidence behind it, really none of our stuff supposedly matters, when my resource list for physiologic birth alone is 183 resources. So this is where I have a caveat on evidence right now, and I’ve been thinking a lot about the stuff happening on social media about it. And I think we can’t disregard our experience, because if I’m going to speak to maternal satisfaction, by the time they push by five hours, their face literally doesn’t even look like them.

I pushed for nine hours, twice with the same patient. I had her twice, and she just had a horrific time getting this baby through her pelvis. She did have two vaginal births, but by the end, she had-

At what cost.

Right. Right. She did have second degrees, she did have horrific vaginal recoveries. Not to say she should have had a C-section. She’s very happy with her experience, but would it have been more helpful to wait on pushing for two of those hours? And actually, with the last one, we paused to labor down for two hours in the midst of the 11 total hours of the pushing time. That’s a lot, yo.

That’s a lot.

That affects your experience.

Well, okay, so I have two things-

That’s my rant. That’s my soapbox, jump in.

I love that. I have two things to share. So one I wanted, before I forget, they did talk about how much delaying actually decreases the pushing time.

Oh, okay.

It wasn’t as much as I thought. So all the different studies were a little bit different, like nine, 11, 12, but Cochrane summarized that it’s about 19 minutes less of pushing when you delay. Now, anecdotally, that does not feel appropriate to me, because I do know that, I’m like, “I’ve pushed for a long time.” And then, when you delay, sometimes it feels like, “Oh, you pushed 45 minutes and you’re done.”

You just don’t know though what’s actually going to happen.

You don’t know. You don’t know

You don’t have the experience of both sides with-

Right.

… the same-

Same patient, right. But I do want to say that that post that you were saying that I shared with you, that was shared to me it was lived experience, informed practice, which I thought was really nice. So that was kind of the social media idea.

And I’m going to share something with you, Sarah. And I heard someone do this on a podcast once, so we might not-

Oh, my God.

… share this, but I’m going to share it right now, and then we’ll decide if we’re going to let it go through the edit. But I got a DM when I was talking about this on Instagram from a nurse that was working at one of the hospitals that was doing one of these studies. And I-

Studies on lived experience?

No, sorry, laboring down.

Oh, okay.

And the nurse told me that the group that was laboring down, the residents told them, “Do not change their position.” So that comes with what you said, who’s motivated by the study, if the authors want to prove that laboring down isn’t beneficial?

And who’s actually holding people accountable to give an unbiased opinion?

And so I think that lived experience, informed practice is important. And I think as a generation that we are growing up to really try to read all sides and get the truth in things. What I really appreciate about my Gen Z generation that I’ve learned is they’re going to fact-check and they’re going to see what’s the truth and they’re going to dig in for that information. And it’s really inspired me to do that instead of just taking something front value, because I’m that kind of person that you can convince me of any conspiracy theory.

And I’m like, “Okay.” I sway, but I’ve been learning to be like, “I’m going to look a little further.” Or I’m going to listen to you, hear you, but then in my head I’m like, “I’m going to check into this. And so I think that’s really important too as labor nurses and birth workers, to hear people listen to them, listen to their lived experience as well, and then take it all in and analyze it yourself and just be open to different ideas. But, ultimately, like you said, what does the patient want? What is trauma-informed? What is their clinical scenario? Because you shouldn’t marry one idea.

That’s what the evidence says.

I guess if you have a provider that’s like, “Absolutely not, you cannot labor down.” You could bring up the Cochran, that would be smart. It’s free. Just type in Cochrane laboring down and be able to just be like, “So what do you think of this? They did-

Mind you, after you’ve talked to your patient and helped get informed consent on what do they want to do? And this to me is we sort of have to categorize epidural or non-epidural, because if they don’t have an epidural and they don’t feel the urge to push, to force them to push when they have all of the innate tools, resources, sensations to know when it’s time… Part of the fetal ejection reflex is, you mentioned this, fetal ejection reflex or Ferguson reflex, is basically this feedback loop of hormones in the body where the head puts pressure on the cervix, which is why we want dissent. We talk all about this in our physiologic birth class. And then you get that pressure on the cervix, which releases prostaglandin, which tells the brain, “Release more oxytocin,” stronger contractions, more pressure on the cervix, more prostaglandin release, more oxytocin.

They work together, and it’s like it increases the strength and frequency of the contractions. And fetal ejection is the idea that you’re actually, the body is ejecting the fetus, and on its own, it can eject the fetus from the body. And so as you’re laboring down with instinct, there will come a time, and I’ve seen it both ways, where the baby… we know for sure that wheelchair sign and like, “Ugh, oh, my God, it’s coming.” You can’t help yourself, but push at times. But there’s also times where the head isn’t as applied or for whatever reason, they’re like, “No, I…” There’s this restitution of labor where all of a sudden it’s so intense, so intense transition, moaning, groaning, freaking out, and then you get to complete. And then there’s this lull period of time that naturally and physiologically, a lot of times happens.

Sometimes it happens for five minutes, sometimes it happens for an hour in between where people are almost napping, they’re resting, there’s like this lull and then it starts to pick up again as the body is now ready for birth. But we don’t ever see that, because we’re augmenting, people have epidurals. And that that’s nothing against augmentation or epidurals, but it’s just like we have to understand this is why physiologic birth as a foundation for your practice is so important that you understand what’s happening in the body, so that you can recognize it and support it.

And so if we were looking at it without an epidural, let them do what they want to do. And any provider, to me, that’s saying, “You need to make her start pushing,” or, “I’ll be there in 10 minutes. Talk to your patient. What do you want to do? She’s not naturally pushing. She will have the instinct eventually, I will call you when they’re ready to push.” That’s the without the epidural situation. But most of our clients or patients have epidurals.

So then they lose that instinct. They do not have the same sensations that somebody that doesn’t have an epidural does. And so then it’s your chance to say, “The data is very neutral on this. Some would say that it increases your chance of hemorrhage or bleeding too much after birth. If we labor you down, what that means is we wait to push for a while. How do you feel? Here’s what the studies say. Here’s where there’s benefit. The reason why people like it is because can help to save you some time pushing. Statistically, we’re talking about 20 minutes, but that’s a 20-minute nap if you want it. And so what feels right to you? What do you want?”

Before you even talk to your providers. And then you say, “Hey, she’s complete. She would like to take a nap and labor down for a little bit. How do you feel about that?” By a little bit, let’s decide on a number. And in the meantime, we’re not leaving them there, not touching them.

We’re not in high thrones, knees out.

Oh, my God, I’m going to lose my mind.

So if you’re going to labor down or allow for passive dissent, there are some things we can do to promote that. And hopefully, you have taken our physiologic birth class, and if you haven’t, you should. There’s one in February. This episode will go out early February, and our next class is the end of February, and we don’t have another one until September. So if you are someone that wants to join that class, you still have time, we can get you your supplies. But Sarah, queen of physiologic birth, and I know you’re going to be like, “You have tips too,” and I do, I’ll share, but I’d love for you to share some laboring down tips that you have.

So I sort of think about it in two ways. One is the disposition of the patient and what they’re feeling. If they are totally wiped out, the goal is a nap, right? So it’s get you into a new position, we’ll talk about positions in a second, but let’s get you into a new position, and let’s let you stay there, and I will be back in 20 minutes to change your position. Up until this point, we say, and we recommend position changes every 30 to 45, ideally, no more than an hour, if you can. We know that your job limitations… We get it. It’s flex and flow. But in general, if you have the space and time, prior to that, it’s every 30 to 45 minutes.

Now we’re bumping it up to every 20, because you do have the mechanics of the pressure on the cervix, the baby is low enough, and you want that rotation, you want to encourage that rotation and that movement motion is lotion through the pelvis. So now position changes bumped to every 20 minutes, and in the meantime, if they’re tired, you help them sleep.

The other thing is that I have started doing is two things with my clients. One is the laboring down breath. So you’ve heard of breathing the baby down, and actually I have a YouTube video we can link in the references below on breathing. And the last breath that I teach in that YouTube video, and actually we’ll talk about it in Cancun as well, is a “breathing the baby down breath,” where you’re actually engaging the internal pelvic floor to breathe into the pelvic floor to increase the pelvic pressure. It’s sort of a passive push, but it’s not really a push. And actually I’ll explain it really quickly here.

So if you put your hands on your abdomen, I feel like I’ve shared this before, but whatever, repeating is helpful. So you put your hands on your abdomen and you breathe in deeply to a deep abdominal breath. We hear about deep abdominal breath, so fill your lungs all the way down so that your belly poofs out, and then when you breathe in your belly poofs in, it kind of moves with your breath. Now think about your diaphragm, as you continue to breathe deeply. When you breathe in, your diaphragm is going to go down, and push all of your abdominal organs down. Because it’s putting a passive pressure, or it’s actually an active pressure, on those organs.

The other thing it’s going to hit is the bowl part of the pelvic floor. So as you breathe deeply, it pushes on that pelvic floor and creates a subtle little push down. Now, how you actively, and I teach this to my clients when we’re waiting for a doctor or if we’re laboring down, is to try this breath. And when you breathe in, your belly goes out, and when you breathe out, keep your belly out. So it’s where there’s this very subtle, when you try… And literally you should be trying this to feel what I mean, that we’re not pushing, but we’re adding just a smidgen of pressure on the baby, on the abdomen, on the pelvic floor, the whole area in the direction that we’re trying to get the baby out.

So that is a passive but also active way to help slow their breathing, down regulate their nervous system, and then soften their pelvic floor, and actively give them something to do in the meantime, unless they’re desperate for a nap. Then if they’re desperate for a nap, then they should sleep, and oxygenate the uterus, oxygenate the body, the baby, et cetera, to help the situation. So I do that pretty much with every client.

The other thing I have them do while I’m there is visualization. And this, as nurses, we’re like, so like, “Oh, it’s all hokey pokey,” and some of us are into it. Some of us are eye roll. To be honest, I was kind of the eye roll type back in the day. And now that I’ve seen as much as I’ve seen from the beginning to end labor side of things, I’m like 100% a fan of visualization. I used it in my own life. I meditate in the mornings. I did not this morning, but I’m going to go do it later. And I really have found this to be helpful, not only for nervous system activation, vagus nerve activation, which also is simulates your parasympathetic nervous system.

We want to down regulate their nervous system, not only for their own stress response and trauma, it can be stressful. There may be things going on in their head. This is their transition to parenthood, which I’ll talk about in a second. But also because our labor hormones work in a parasympathetic state. And so you’re actually helping the natural body hormones to work better for oxytocin to continue to increase, release that prostaglandin, help the baby down through the birth canal.

But there’s also this idea of this is a moment in their life that has the potential to be missed. That when you have even a 20-minute window, a 10-minute window, I do this with every client, when there’s in that zone of pre pushing, and sometimes it goes really quickly if we’re not laboring down or like, “Oh, give me a push. Oh, the baby’s coming. We’re setting up.” Totally different story. But if you have that lull to have them close their eyes, visualize this baby coming down through their pelvis, through their cervix, down onto the bed, visualize it coming out/just take a moment to savor this moment.

This is a lot of times when I’ll actually step out of the room, and I’ll be like, “Do you guys want a moment alone to catch up,” if they have a partner with them, “to just have an intentional stop and pause and special time together?” And I’ll say this, “This is your last moments with it just being the two of you.” And so take a moment to kind of settle in, talk about that. Some families will pray, or some families will meditate together or they’ll cry or they’ll hold hands or they’ll snuggle or they’ll kiss. And all of that is great for your hormones, too, for labor.

And a lot of times I’ll give them that privacy, come back 10, 15 minutes later. They’re in a very zen state. And then also in that time, that’s your opportunity to talk about pushing. And sort of when they’re doing that breathe the baby down situation that it’s this active… You’re imagining what it would look like. Or if they’re starting to feel pressure with an epidural, instead of pushing, to start connecting brain to body in that way of what would it feel like to bear into, push into, to add pressure to the sensation in your vagina, in your rectum, because that’s where we’re going to be?

Because too quickly, and honestly, this has also become sort of one of my pet peeves in labor, specifically related to pushing, is when the provider or somebody comes in, they check you, “Oh, you’re 10. Okay, now push. Okay, push. Go 10, 9, 8, 7, 6. You got it. Almost there. Okay. No, no, no, no, no, no. Okay, reset. Grab behind your legs. Lift your head up. No, tuck your chin.” Like, “Whoa.” It doesn’t have to feel that way. All of a sudden you even probably sense the energy that I brought.

And we all know, we’ve seen it hundreds of times. And so you as the gatekeeper to the experience, as Justine says, that that’s an opportunity to say, “San I jump in here?” Or, honestly, I’m anticipating that this is going to happen. So I’m warning them and I’m giving them all those little floffy tips and sensations and visualization and what does it feel like to push? Let’s talk it through. “What’s what they’re going to suggest to you is this… If that doesn’t feel good, say something. Or if there’s something else you want to do, say something. Some options might be this…” et cetera, right? “We’ll probably start here until you get the hang of it, and then we’ll try changing positions. We’ll get you on all fours, we’ll get you on your side,” et cetera.

So I think a lot of times we think, and I think probably what you were anticipating, you meaning anybody listening to this, was anticipating me going into position changes. And I think so frequently we as nurses, position changes are the hot topic. They’re so exciting, and we have so much fun trying to figure out how to get the baby through the pelvis. And now that you’ve taken physiologic birth, you have the tools to do that. You’re using your position guides, yay. But it’s so much more than positions, and there’s so many more things.

Even if you can’t turn your patient to the side, because they have decels, and you’re stuck in one position, just shift their weight. And then do some of this other stuff to help support a physiologic labor. So those are my tips for the laboring down portion of how to make the most of it from a non position standpoint. And then honestly, you have your position guides. You’re changing positions now every 12 minutes. 12 minutes.

I like that. Let’s do 12 minutes, no.

I mean or every 12, mind you, that’s like barely enough to get a couple contractions in. So every 20 minutes you’re changing positions, and then you’re switching it up with the idea of understanding where is the baby? If the baby’s at zero station, those positions are different. You have your position guides at your bedside to reference, but really it’s knees together, knees parallel. I, honestly, because you don’t really know where the baby’s at, I’m going to go towards a more parallel, open knees together position that could just be shifting a peanut ball towards their feet, not between their knees, and then throwing a pillow between their knees.

You’re doing all these things to activate contractions and help rotate the baby, et cetera. Then you also want to create space in the pelvis that you’re not actually actively closing the place that the body’s trying to bring the baby into. And I’ll say, for me, you give me 30 minutes with a client and you’re doing all of these things, and you’re changing positions probably twice in that amount of time, and massaging their ligaments and helping them with visualization. By the time they get to pushing, they have such a better experience.

Not only because of the psychosocial side of things that you’ve prepped them for it, and given them some transitional time in their brain to do the hard work, and also motivating them and pumped them up that, “Now you get to be active in your experience. Up until now, we’ve just waited and now you have another layer of control, which is so fun and exciting. And you’re at that finish line. You’re seeing that finish line in the future. You got that mile left of the marathon. And so it’s literally one step in front of the other, one contraction at a time, one push at a time, giving it your all. And this baby is coming.”

Now I’m motivated to go push with a patient. And I got to say I’m not usually motivated to do that.

You’re welcome.

That’s great.

What tips do you have, Justine? I know I just rambled for a long time, but…

No, I think all of that was good. And it’s funny because I did think you were going to go towards position. I was probably going to go more towards what you said, but we did mention the no throne, don’t do throne. If you listened to that and you were like, “Wait, why?” So Sarah and I hate throne, that’s fine. But our experience has been that-

Throne for a long time.

Yeah, nurses have left patients in throne for a long time, and they’ve left them in throne and not paid attention to their knees or ankles, based on where baby is in the pelvis. And so what does that mean? If your knees are out, is your baby minus two, then, okay, you’re trying to get baby into the pelvis. Is your baby plus one plus two? Then let’s throw those knees together. That’s important. So where’s the baby?

And then we have seen that if they go into throne say at eight centimeters, nine centimeters, and you’re trying to get baby down, like, “Oh, I really got to get baby engaged on that cervix to dilate it,” we love the idea behind that and you are on the right track. But-

Because gravity is good.

… anecdotally and our… Yeah, gravity’s great. But anecdotally, and based on our lived experiences, we’ve seen a lot of swollen cervixes because of that. And so just be mindful of throne is not the answer to everything.

Well, and that swollen cervix is particularly with our epiduralized patients who are there for a while.. Because not only with the sacrum moving out of the way, the sacrum cannot move when you’re sitting on your butt like that

And your fascia’s crystallizing.

Your fascia’s crystallizing, because you’re sitting there for so long, and the perfusion to the cervix is shifted. Now, if you don’t have an epidural, you, meaning your patient, doesn’t have an epidural and they’re say squatting and going into a squat position or “throne position,” or they’re in a supported squat position, they are going to be shifting their weight enough that that perfusion is happening. But think about ourselves. You try to sit for 45 minutes without shifting your weight, and by the end you’ll be having a panic attack, because of the lack of the pressure on your sitz bones, on your pelvis, depending on the angle, et cetera.

And so it’s like we constantly are shifting our weights, and this is why pressure ulcers happen, which they can happen in labor and delivery. I’ve never seen it, but you leave them there long enough with an epidural that actually can happen, because there isn’t blood flow to the area.

And so if you’re going to use a throne, think about it strategically, know where the knees are, you can prop up a little towel under the booty. I know you have an Instagram post on that. We talk about it in physiologic birth. And then also don’t leave them there forever. We’re talking, honestly, if you’re going into throne, it is a max 30 minutes. But at the 20-minute mark, we are strategizing where to go next. We’re shifting weight. We’re moving around. We’re trying something else.

So I love the idea of gravity. I love even a squat at times is great, but even better would be an all fours position, a W position. They’re on our position guide on the plus station outlet positions, but flip them over and support them with a peanut ball. And I know that we’re getting more and more used to that. But also until you try it, you don’t necessarily realize how helpful it can be. And an all fours position for laboring down, to me, is like, if I can get them there, that’s my ideal.

Because it does allow for so much mobility in the pelvis, and in the sacrum, and they can breathe and relax and still do their laboring down. And then probably what happens is the provider walks in the room and they want them in lithotomy for a second. And so at least you’ve done some of that rotation work. If they’re at all OP, if they’re at all kind of lodged and need to make that final rotation to OA, that an all fours position’s going to actually help them do that.

And with the all fours position, you guys, you can put the peanut ball like a smaller peanut ball in front of them to help support them, because that can get pretty exhausting as you know. Grab a friend, if they have an epidural, to get them into the all fours position. And remember, wasn’t it when we filmed our coping and labor class, we realized how much more comfortable it is to put pillows under your knees, between your knees when you’re in all fours?

Oh, yeah. Or I don’t know if it was then, but I always throw a peanut ball, like the smallest peanut ball you can find in between their knees, so that they’re straddling the peanut ball, and then they can just relax, entirely.

Yeah. Agreed. I personally like runners-

I know you do.

… for early breakdown it’s my… And that’s that lived experience, and I’m probably biased.

Do you use that for non-op babies?

Yeah, I do. I use it all the time.

And you’re determining which direction you want to rotate the baby.

Yeah. So based on-

What if they’re complete direct away?

Then I will still use it, but I’ll… I’ll still use it if babies like plus two, because in my mind, I’m like, “I don’t think baby’s going to flip to OP, when they’re that engaged.” But…

No, they’re probably not. Well, and to be honest, I was thinking about fire hydrant when you said runners. I was picturing fire hydrant, because I think of you as the fire hydrant lady.

I do like fire hydrant, when they’re OP.

Okay, runners is great for laboring down. Absolutely, with bottom arm underneath-

And it encourages that nap. They would get super comfy cozy.

And that would be they want the nap. That probably would also be one of my choices. But I would actually, so I’d put them in runners, and then I’d put a pillow under the top foot to elevate the foot and just do a little twist torque in the pelvis to help open the outlet part.

That’s good.

Not probably a peanut ball. It feels a little too extreme on the joints, just a slight little rotation. But I’m like-

I’ll try that.

… the pillow queen. By the end, there’s like pillows coming out of nowhere where you’re like, “Where did these 25 pillows come from? Whoops.”

That’s awesome. You guys make friends with housekeeping. I learned the that again, the other day that I still need to, I was this sweet lady, and I was helping her clean up the room, tear down the room, and I was like, “Do you know if there’s any secret pile of pillows anywhere?” And she was like, “Oh, we just got our new box downstairs. I’ll bring it up.” And I was like, “Great.” She brought a whole box of 50 pillows that we took out and expanded, and it was awesome. And so-

Aw, that’s perfect.

… pro tip, make friends, ask for pillows. Hide them in your rooms.

You need at least five in every room.

Which-

That’s fine.

… people are like, “We’re lucky to have one,” is what they’re going to be listening to the saying. Or you’re stealing from room to room.

Yep. That’s what I do.

Okay. Well, I hope that that was helpful for you guys on laboring down and we answered some questions. If there’s anything else you want us to know based on laboring down, reach out, let me know. We can always do a part two based on any other questions you have.

But that being said, thanks for spending your time with us on this episode of Happy Hour with Bundle Birth Nurses. If you like what you heard, it helps us both if you subscribe, rate, leave a raving review, and share this episode with a friend. If you want more from us, head to bundlebirthnurses.com or follow us on Instagram or TikTok.

Now it’s your turn to go and take all of it you learned today, giving evidence-based care, integrating your lived experience, advocating for your patients wants and desires, specifically related to laboring down. And then being really intentional with how you approach the very beautiful period of labor, where you have that little lull to potentially labor down and add a lot of intention behind your actions, to help them not only push less, but have a more positive birth experience. We’ll see you next time.