The Natural Alignment Plateau
N.A.P- Natural Alignment Plateau.
This natural phenomenon occurs in a large number of births, but is rarely talked about in the modern world of obstetrics. Im not even sure that doctors & nurses have been educated on this naturally occurring event in their formal eduaction.
The N.A.P. is a normal period of time in many labors when dilation of the cervix is not increasing but uterine activity continues.
Dr. Emmanuel Friedman was the first doctor to create a graph of how a woman “should” dilate. The name of this graph, which is still used today, is appropriately called Friedmans Graph. He determined that it was best for a woman to dilate 1 cm / hour until reaching 10cm. Here is a picture of his graph.
The problem with his chart is that MOST women do not dilate according to a chart or graph. The same Bell Curve concept applies here as it does in anything in life. While many will coincidentally dilate in a similar pattern of 1 cm/ hour, there is a giant bell curve of women that will not!
The Natural Alignment Plateau is one example of what many women commonly do. A woman will be in labor and seems to be “progressing” just fine, and then “stall” out around a 5 (average, a 5- can be any number though) and stay a 5 for hours. This is OFTEN when a doctor or nursing staff will tell the mother that she is experiencing “failure to progress” and want to start her on Pitocin, or they may not even state that its Pitocin that they want to put her one, but instead just tell the mother that they are going to give her “a little something to speed things up”. Once Pitocin is introduced a whole spectrum of things can go wrong (see my blog on Pitocin, for more info). The most common progression of labor when a woman is experiencing the N.A.P. is she will seemingly stall out at a specific number for a period of time, an hour, many hours- it varies. However, what usually happens with the N.A.P. is a rapid dilation at the end. An average of 20 minutes from whatever number you were “stalled” at to completely dilated, is what often occurs in women who are experiencing the Natural Alignment Plateau.
There are many reasons why the N.A.P. is important and a necessary step in labor. I will name only a few, but there are even more that we do not fully understand.
Reasons for Mom: A woman’s body can know that it needs some “extra time” in labor to make sure all the I’s are dotted and T’s are crossed. Moms body creates a lot of hormones while going through labor. All of these naturally occurring hormones happen for independent and important reasons. If a mothers body is needing to release more of one or more hormone, her body will continue to contract, but dilation will stop, as to force labor to rest for a time. Progression is still occurring, but her body will not be working as hard, giving it time to do whatever else it needs to do before baby can be born.
Reasons for Baby: There are many reasons the baby may “call” for a N.A.P. to occur. Each time a mom has a contraction the baby gets squeezed very tightly. This is a good thing, as it stimulates the baby’s nervous system, however, sometimes with the intensity of labor a baby may need labor to not increase in intensity as quickly as it was before. The baby can signal to the moms brain that it needs the contractions to not get more intense for a period of time, while baby rests. The number one cause for Fetal Distress is when a baby tries to signal to the mom that it needs a break, and that break is not given. When Doctors jump the gun and put women on Pitocin because they have “stalled” in their labors, they are putting these babies lives at risk and increasing the likelihood of fetal distress. As talked about more extensively in my Pitocin Blog, once Pitocin has been introduced into the blood stream, the baby loses communication with the mom and labor is now being controlled by the nurses & doctors who control the level and amount of Pitocin going into the mothers blood stream, via IV.
Something that ALL women walking in the door for their births need to know, is that the ‘numbers of progression’ are simply a guessing game. Your body knows best when it comes to laboring. Understanding that our bodies do what they do for a reason, and interfering with our body due to misguided education, or understanding, can actually take what was meant to be an amazing and life giving experience and turn it into a spiral of intervention that leaves you feeling disappointed.
The Natural Alignment Plateau is very normal and very common. Being able to understand what and why your body is doing what it is doing, can help you stand up for your birth experience when the doctors or nurses tell you that you are experiencing “failure to progress”.
Here are some links to various sites and pages for more information about the Natural Alignment Plateau. I hope you enjoyed this little tid-bit on an expansive topic. As always- please leave your comments, I love hearing what everyone thinks. 
-Julie
Links-
http://www.birthingfromwithin.com/laborinth
http://www.naturalchildbirth.org/natural/resources/glossary/glossary.htm
http://www.parents.com/pregnancy/giving-birth/stories/one-mom-chooses-an-unmedicated-birth/?page=1
http://www.birthingnaturally.net/birth/progress/progress.html
| Print article | This entry was posted by Julie Wannamaker on December 23, 2009 at 3:44 am, and is filed under Baby, Labor/Delivery. Follow any responses to this post through RSS 2.0. You can leave a response or trackback from your own site. |
- To Push or Not to Push…
- What to Ask When Picking an OB/Midwife
- Pomona Chiropractor Provides Natural Therapy For Headaches
- Tweets that mention The Natural Alignment Plateau | Natural Childbirth Education — Topsy.com
- The Number Trap
- Ashley’s Birth of Hannah, or, A Memorial Weekend to Remember – Lana Joy
about 2 years ago
This is a great topic and can help so many women if they know this. I skipped this topic and may not have remeberd it anyway…but I had a long transition and it took two hours to go from 8 to 9, and I started pushing [too early]. Things went from there toward exhaustion with no help with my body and I had a cesarean. Looking back after endless analyzing, I just needed to wait it out more and wish I had and wish my midwife hadn’t suggested pushing.
You should also addres pushing for first time moms sometime, maybe you have already.
about 2 years ago
Hey Alicia! I should do more research about pushing. It’s a topic that I stand on the fence about right now.
There are lots of studies to suggest that if mom is feeling the overwhelming urge to push before she is fully dilated, that she should go with that urge. They also suggest that by NOT going with the urge, the cervix may swell, preventing dilation and increasing risk for a c-section.
Did you feel the strong urge to push, or were you just “stuck” at an 8 and she recommended you push in order to help “speed things up”?? That would be an interesting perspective to look at.
There are studies on the flip side to suggest that by pushing when your body is not ready and put that much added stress on the cervix, it can cause swelling & if kept up can rip or tear the cervix.
I would be curious to hear which one yours was. I would love to use your personal story in my blog when I write it, if you are okay with that?! Comment back, let me know if you had the strong urge to push when you did or not. My thinking cap is on!
Julie
PS- I got your text the other day, thank you so much. It’s okay to post comments on that blog too- there are 26 of them on my iWeb account, I just haven’t had the time to move them over to the WordPress one.
Thats todays project while the kids nap. 
Missing you guys, maybe we can plan a summer trip to see you?!?!
about 2 years ago
OMG. My little boy is 2 on Monday and this is so timely to read after his birth and all the trauma of it. I had often thought that there was a reason why I slowed but I just couldn’t vocalise adequately and have questioned all this time my mind and heart’s commitment to my VBAC and whether I was convincing myself it was too hard, even though I was coping fine at 15hrs and managing without any distress to me or him. Thank you so much.
about 2 years ago
L- You’re SO welcome!
Thank you for sharing. 
about 2 years ago
Thank you so much for writing this. This happened with my first. I got “stuck” at 5 cm after many exhausting hours of labor. My m/w recommended Stadol which helped me sleep for about 2 hours, after which I was “still” a 5. She then recommended an epidural. It was the only time I cried during labor – ever. I didn’t want an epidural and pitocin. I wanted to feel everything. Well, I got my wish. The epidural didn’t work! It only numbed my leg. However, baby ended up needing an internal monitor.
It makes so much sense reading that once they intervened the trouble started.
With my third one I went in knowing it was “it” and was only at a 2, where I got “stuck” for a few hours. After pitocin was started I went from 2-10 cm in an HOUR (no epi)! While pushing, the m/w sternly warned me that I needed to get the baby out quickly b/c he was in distress. My 2 pitocin babies. Hmmmm . . .
Oh, and with my fifth, I had NO PAIN through the entire labor – until I pushed with the urge to push at the urging of the medical staff b/c I was complete. NEVER doing that again!
I was in awe reading your article at how much sense it makes and was SO grieved reading that the baby loses communication with the mother once intervention has begun. :*( Thank you for posting this! I’ll remember this should we be blessed again!
about 2 years ago
Joy! Thank you SO much for sharing your many amazing birth stories! You’re right to pick up on the distress being in your Pit babies… there is often a correlation! Thank you for reading & for sharing.
about 2 years ago
what an awesome article! I think I experienced this with my first, born at home. labour stalled for a little while. I have always been angry that someone dared to suggest i stalled. Who cares! I needed a rest and did what my body told me!
about 2 years ago
Interesting…
I am a birth doula and had a recent client who was “stuck” at 6cm for 5 hours, and then “stuck” at 7 cm for another 3 hours. All this after already being in labor for over 20 hours. She did everything “right” to help labor progress, but after laboring for so long, and laboring hard with transition-pattern contractions with no cervical change, she chose to receive an epidural. Once the epidural was placed, she was able to sleep for a couple of hours, and still made no cervical change…contractions stopped altogether. And, of course, pitocin was eventually used to start her labor again.
I suppose I’m wondering at what point the “stalled” labor truly requires some intervention? Even if it is not necessarily to progress labor, but to offer the mother some relief?
After all, here was my client who was committed to a natural birth, and labored beautifully for 28 hours. Who, upon being checked found out there was STILL no cervical change after having 1.5 minute contractions, 2 minutes apart, for 3 hours. Who looked at me, and said, “Sarah, I just can’t go on like this anymore.”
Thoughts or comments in relation to The Natural Alignment Plateau would be appreciated.
about 1 year ago
I am beginning to have mixed feelings about checking dilation, just because of the emotional and psychological feelings it creates. My labors are waaaaay not textbook, They have gotten longer each birth instead of shorter, and one time I dilated to 9 only to be checked an hour later and I had returned to a 4. The last labor(baby 4 all homebirth) I got to five around hour 10 and I started to cry. It felt like failure to me, and futility. I appreciate this article alot, because for this baby maybe I will remain aware of potential plateaus during labor. I have doulad at births where the mom was told not to push but to allow her body to push(she was a t a 9) and she said it was so much less painful than her first baby. I am not a writer so much as a rambler, but I hope I have expressed what I tried to.
about 1 year ago
Great article! Labour with my son was “sped up” with pitocin, which they increased after I had an epidural….my little guy had to have his breathing monitored and had trouble feeding. I had a painful recovery period and pretty bad PPD. This time around, thanks to posts like this one and tons of support from other knowledgeable, birth-trusting women, I am planning an at-home waterbirth with little to no intervention getting in the way or undermining the natural course of labour:)
Thankyou for this insightful article; I’ll be keeping it in mind when my baby’s time comes:)
about 1 year ago
i had an amniotic leak and no contractions for 24 hrs so was induced with 1 dose of gel applied to my cervix. i ended up getting a c sect 22 hours later. i never got beyond 1.5 cm. my large baby also went posterior during labour. i will absolutely not allow an induction ever again.
about 1 year ago
the same applies when a plateau happens after full dilation, right? So cervix 10cm, but contractions fase out (to even every 10-15 minutes) & become ‘weak’ (definitely no urge to push), mom becomes very sleepy (and actually sleeps in between the contractions). Have you had experiences with this? How long this plateau can be there? How long one can wait? Thanks, Joyce PS great blog, thanks you so much for your very insightful info.
about 1 year ago
What you’re describing, to me, sounds less like the N.A.P. and more so like a woman who for whatever reason is not experiencing the pushing sensation. There is a small number of women that simply never get the “urge” when fully complete. This can be due to a variety of reasons. Sometimes a slight misalgnment of the babys position can cause the baby to be just off the tailbone, which in turn would not press along the muscles responsible to creating that urge.
Let me see if I can explain that better. When a woman is complete & experiencing the urge to push, the typical placement of the head is along the bowel, the head pressed along the tailbone & rectum creating the identical sensation as if she is having a bowel movement. Sometimes women either simply do not experience this feeling at all or they don’t experience it right away, but after some coaching & help pushing the sensation kicks in once the baby is deeper into the birth canal.
When you describe the ctx’s getting futher apart & changing in intensity- you are describing *classic* second stage (pushing stage) contraction. They very often space out & become less painful. There is even the abilty for mom to snag some rest inbetween them, for sure.
The NAP is usually only when a woman is not fully dilated- up to about 8cm dilated, although no one certain cm is the only one. It more often then not happens around a 5-8cm’s. When experiencing the NAP too the ctx’s do not stall out necessarily- they often keep going just as they were before, they just simply don’t increase in intensity, duration or frequency until the NAP is over.
I hope that makes sense! Thank you for reading & the sweet complement on my blog. I appreciate it.
~ Julie
about 1 year ago
I SWEAR this is what happened during my VBAC labor, and I am SO SO SO glad I listened to my body and wouldn’t let them give me Pitocin. When they finally left me alone (after 24 hours at 6 cm) I shot from 6-10 in just a couple of hours. It was crazy! I never understood why – but I always assumed that my labor had stalled because of all the threats to section me. Now I think my baby (and my scarred uterus) needed a little rest, and THAT’s why things slowed down. And my stupid, stupid, stupid OB wanted to override my body’s own good sense.