App-Assisted Labor: Smartphones During Childbirth Are All The Rage, But Do They Help?

When Juli Simon Thomas gave birth to her son last year, she wanted a generally low-tech environment: a midwife instead of an ob-gyn, a quiet room and no drugs. "I was bound and determined to avoid an epidural," she said, even despite 25 hours of labor.

But Thomas had one important, technical requirement: an app on her smartphone that allowed her to precisely track her contractions.

"I use my phone for everything, and this was really helpful," said Thomas, 35, a post-doctorate fellow in population research. "The process of labor is so variable, and what you end up hearing is how you have to 'go with the flow,' 'see how it turns out,' 'just relax and wait' — I can't do that. This gave me something more concrete to focus on ... Just standing around in various levels of pain while breathing wasn't a good choice for me."

We already date, order takeout and document supremely intimate moments on our phones. So it's no surprise that smartphones have also permeated the realm of childbirth.

contraction timerPeople in the birthing world say labor apps have become ubiquitous — part of the landscape and akin to written birth plans, which were all the rage a decade or more ago.

Rise Of The Labor App

According to the iPhone App Store, there are at least 80 "labor apps" alone that help women time their contractions to assess how close they are to giving birth. Some are free, some aren't. Some have advertisements for infant formula, some don't.

Moms who’ve used them say they all operate in similar ways, usually with start-and-stop icons you press at the beginning and end of each contraction in order to record duration and frequency until you get to the magic number 5-1-1. (That means contractions are 5 minutes apart, lasting 1 minute each, for 1 hour.)

At that point, doctors and midwives pretty universally want you to call to determine if it's time to get to the hospital, or for a home birth, get a practitioner to you.

Of course, there are also apps for pretty much every aspect of pregnancy, birth and postpartum as well: from tracking the baby's kicks and mom's breast milk production to documenting hours of sleep (or lack thereof) and diaper use. In 2013, ABC News reported that nearly 50 percent of total mobile subscribers using one or more health apps are using a pregnancy-related app.

Elizabeth Henry, 36, of Cambridge, Massachusetts, stood by as her husband worked out her contractions on a Microsoft Excel spread sheet when she gave birth four years ago. When she gave birth in July, she used the Full Term contraction app on her own while her husband watched their toddler. "I'm a data person, and this app kept me honest. I was trying to do last-minute things in the house and stay home as long as possible, and I didn't think the contractions were coming so fast. But then when I looked at the screen, I saw it really was time to go to the hospital."

Not Everyone So App-Happy

Labor doesn't always unfold in a predictable pattern.

And for years, there's been debate over what constitutes "normal" or "abnormal" progression in labor, including whether or not there's any true benefit to tracking contractions.

Also, if women are staying up all night tracking contractions with their apps, that could lead to exhaustion, which is not a good state to be in before giving birth.

Beyond that, says Michele Anne Helgeson, a certified nurse midwife and director of the midwifery program at Brigham and Women's Hospital in Boston, there may be a downside to the the rise in app use, and more broadly, the reality of women and their partners getting so much birthing information by downloading.

"It's my personal belief that these apps have taken the place of what was previously learned in childbirth classes," she said. "Those provided social interaction with other couples going through the same thing, and there was a chance for community building, and there was a focus on normal physiological birth. But the culture has shifted away from non-medicated, low-intervention birth and toward a range of pain relief measure, such as pain medication and epidurals."

Indeed, the ways in which expectant parents get information has changed in recent years, Helgeson says, adding that people think: Why should we spend weeks at childbirth class when everything is available by app?

"The app is a very wonderful tool and it has lots of pluses," she said. "But the consumer has to be careful to balance that with information they'd be getting from their provider, which is generally much more personalized."

One example Helgeson offers: There's is an app to record and listen to the baby’s heartbeat but one of the risks is that it can also record the mother’s heartbeat so the woman using the app could get falsely concerned or reassured.

A Good Distraction

In an informal online survey of Boston moms, the labor app mentioned most often was called Full Term, originally created by Mustansir Golawala in 2010 for use in his wife’s labor. The app can list the time of every single contraction for you. Or, it can calculate the average length and frequency of your contractions over the past hour, and over the past six hours. Additional features include: the fetal kick-counter on Full Term, 3-D fetal development images on an app called Sprout, and the ability to post updates about your contractions to Twitter and Facebook with the Labor Mate app.

Amanda Forgit, a birth doula in Ashland, Massachusetts, said in an email that these apps have become standard practice. “Most of my clients are using apps to time contractions and will even text me screenshots to update me on how they are progressing while we are apart,” she said.

Some women said the app was simply a nice distraction at a stressful time. Caroleen (who didn't give her last name) said: "I thought it was fun to use the app — it felt like I was playing a game! As soon as a contraction was over I’d be like, 'Ooh, what score did I get this time?' "

Still, it's worth remembering that babies will be born on their own time, regardless of any intensive data-collecting. And there is a sense in some corners that apps have no place in labor.

A Labor App, Seriously?

"I've always laughed a bit about apps that time contractions," says Dr. Adam Wolfberg, director of clinical effectiveness at Athenahealth and an obstetrician at Newton-Wellesley Hospital. "If the woman needs an app to know when she's contracting... Seriously, never really seen much use for labor apps, by docs or patients. I just don't see them in the labor room."

Meg Gaj, from Arlington, Massachusetts, says for her, the labor app was a little misleading. "We labored at home for 18 hours before going to the hospital, [using] the Sprout pregnancy app. Really helpful in talking with our doula on the phone (and later the midwives). That being said, we jumped the gun, and spent another 32 hours in the hospital before the baby came! I think the app made us think the contractions were speeding up, but with no basis (as first-timers) we didn’t realize I was still in pretty early labor, and probably could have labored at home for a while longer."

And there are exceptions to the 5-1-1 rule.

For a small number of women, contractions stay spaced out at seven or eight minutes apart all the way until the end of labor. For another small percentage, the duration of each contraction never reaches a full minute. In these cases, some women report the sensations of labor were so overpowering that even though their contractions did not match the textbook description, they knew that birth was imminent.

Other moms still prefer to focus more internally during labor. "I found I didn't need to know the timing of my contractions," emailed Megan Shaw, of Cambridge. "I became so immersed in my birth and none of my care providers spoke with me about any numbers during labor. I found it reassuring to not be told numbers. Everything was at my pace and the pace of my baby."

But for Simon Thomas, who gave birth to her son in Los Angeles, the contraction app was critical.

"I really needed to know the timing of things," she said. "Because if I had to go to the hospital in rush hour, I would have just gotten stuck."

Readers, what childbirth related apps have you used and have they helped you?

Ananda Lowe is a Lamaze-trained childbirth educator in Somerville, Massachusetts, and co-author, with Rachel Zimmerman, of "The Doula Guide To Birth" (Bantam Books).



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