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  • Writer's pictureNutured Birth Ottawa

4 P's of Labor and Birth: Power, Passage, Passenger and Psyche

Ottawa Doula's model of a baby in utero.

When it comes to birth, many factors play a role in determining how labor progresses. To better understand and explain these factors, care providers often refer to the "4 Ps of Labor;" power, passage. passenger and psyche. In this blog post Ottawa Doula, Julia Davie, explains each of these factors in detail and discusses how optimizing the physiological expression of these elements of birth is supportive of a successful birth experience.

Power: The Force Behind Contractions

The first "P" in our list is Power, which refers to the strength and effectiveness of uterine contractions. Contractions are the driving force behind labor, helping to dilate the cervix and move the baby down the birth canal. These contractions are measured by their frequency, duration, and intensity.

Factors Influencing Power

The body's production of hormones, particularly oxytocin, plays a significant role in regulating contractions. Medical interventions, such as whether someone is being induced, or whether someone has had an epidural, can affect the rhythm and strength of contractions. Other factors that can influence the power of contractions are whether the birthing person feels afraid, pressured or observed. Factors that increase oxytocin such as dimming the lights and encouraging intimacy between the birthing person and their partner will also encourage strong and effective contractions.

Supporting Power

As a doula in Ottawa, one of the key roles I play is supporting the labouring woman to have strong and regular contractions. This support can include various techniques, such as:

  • Movement and Position Changes: Encouraging the birthing person to stay mobile can help contractions become more effective.

  • Creating a Comforting Environment: Ensuring that labouring woman family feels safe, heard, and supported in their desires will reduce fear and support effective contractions.

  • Increase Oxytocin: Fostering closeness and intimacy with their partner (encouraging alone time, slow dancing, snuggles, kissing) and dimming the lights in the birthing space supports the release of oxytocin which, in turn, supports strong and regular contractions.

Passage: The Birth Canal

The Passage refers to the birth canal, which consists of the pelvis, cervix, and vagina. The shape and size of the pelvis, along with the ability of the cervix to dilate, can be important factors in labor progression.

Factors Influencing Passage

The anatomy of the pelvis can vary from person to person, and these differences can impact labor. This does not mean that women need to worry about the shape and size of their pelvis. Our bodies are built to birth! However, variations in pelvic anatomy can contribute to differences in the way babies navigate their birth. Also, the cervix must dilate and efface (thin out) for labor to progress.

Supporting Passage

Supporting the Passage involves encouraging positions that allow for openness and cervical dilation. Some effective techniques include:

  • Seek out body work leading up to your birth: Seeing a Pelvic Floor Therapist, Chiropractor, or Osteopath can be incredibly helpful in preparing the passage way for baby's decent.

  • Prioritizing UFO positioning: Upright, forward leaning, and open positions allow the pelvis to be more spacious, providing more room for the baby to descend.

  • Staying Mobile: Walking or using a birthing ball can keep the pelvis flexible and encourage the baby to move into optimal positioning.

Passenger: The Baby's Position

The Passenger refers to the baby and their position within the uterus. This includes the baby's orientation, size, and presentation as they prepare to move through the birth canal.

Factors Influencing Passenger

Baby's positioning can affect labor. While most babies choose to be in a cephalic (head-down) position, sometimes they may be breech. Some babies are positioned in ways that are a variation of normal, and may make labour a little bit longer or more challenging. While there isn't inherently anything wrong with labour taking it's time, supporting the baby to find optimal positioning can be helpful in making the birth feel more manageable for the labouring woman.

Supporting Passenger

  • Hire a doula who is skilled at using different positions to support optimal positioning: Doulas use a variety of positions to help baby navigate the birth canal.

  • Check out Spinning Babies: This is an excellent resource for fetal positioning!

Psyche: The Psychological Aspect of Labor

The final "P" is for Psyche, which refers to the mental and emotional state of the birthing person. The psychological aspect of labor is often overlooked, but it plays an important role in labor progression!! A relaxed, confident state of mind is supportive for labor. Stress, anxiety, or fear can create tension and slow labour down.

Factors Influencing Psyche

Several factors contribute to the birthing person's mindset during labor, including:

  • Supportive Birth Team: A team that supports your birth preferences, provides encouragement, and helps you bring YOUR best being into being is so important. Screen your main health care provider to make sure that they are aligned with your values, and hire a supportive Ottawa doula, such as a Nurtured Birth Ottawa Doula!

  • Personal Beliefs: These can shape the way the birthing person views childbirth. If someone has been taught that birth is inherently dangerous, their fear may inhibit the ability to relax and allow their body to surrender.

  • Past Experiences: Previous birth experiences or personal trauma can impact the psychological aspect of labor.

Supporting Psyche

To support the Psyche, it's important to create a calm and supportive environment that helps you feel safe. Keep in mind, what makes one person feel safe is entirely different than another, so individual preferences must be taken into account.

Techniques to promote relaxation and reduce stress include:

  • Birth Preparation: Share your fears, worries and concerns with your birth team! You should feel comfortable having these discussions with your doula.

  • Breathing Exercises: Deep, slow breathing can help calm the mind and body and tell your nervous system that you are safe.

  • Visualization and Affirmations: Positive imagery and encouraging words can help you feel safe and encouraged.

  • Emotional Support: Doulas and birth partners can offer continuous reassurance, love and connection. It cannot be stated enough how important it is to have a birth team that listens, holds space, and nurtures your personal birth desires.

Bringing It All Together

By understanding these the 4 Ps of labour - Power, Passage, Passenger, and Psyche - birthing people and their birth teams can make informed decisions and create a positive labor environment to facilitate the normal process of birth.

Birth is a unique and highly personal experience. There is no one-size-fits-all approach. Stay informed, trust your body, and build a supportive team around you. If you have any questions or need additional support, don't hesitate to reach out.

This post was written by Ottawa Doula, and Ottawa Prenatal Nutritionist, Julia Davie. Her approach to birth work is heart centred, holistic and inclusive. She is honoured to support families in Ottawa, Gatineau, and the surrounding areas.


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