A Dice Game to Review Stages of Labor

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Using dice while talking about labor helps to give students a sense of the unpredictable nature of labor and how they need to have flexibility and skills they can adapt to a wide variety of circumstances.

There are two different versions of this game. Here I’ll describe a ten-minute small group activity which reviews information about stages of labor, and helps students to think about normal variations in the range of labor. You can use this as a warm-up activity the week after you taught stages of labor. Look here for another version of the game which can be used to structure either a presentation on variations and interventions, or to structure a labor rehearsal.

Supplies: 12 dice, 3 coins, 3 markers to write with, 3 big pieces of paper, which say:

Labor Begins at ___________  a.m. or  p.m.

Length of Early Labor ____________ hours

Shift to active labor, go to hospital at __________

Length of Active Labor and Transition ___________ hours

Pushing begins at ____________

Length of 2nd Stage Pushing ____________ hours

Baby is Born at ____________

Total Length of Labor _____________

Time: 10 minutes, or more, depending on how much discussion you allow time for.

Goals: Small group interaction, illustrate the range of normal labor, and get students to put themselves into a role, and imagine how they might cope with a specific course of labor. Comparing the three scenarios at the end allows them to consider other scenarios than just the textbook average.

How to Play

Divide class up into three teams – or more for large classes. This works best with 2 – 4 couples per group. Give them their materials. Tell them they’re basically making up a story for an imaginary character and how her labor might unfold.

At the beginning of each section, give the students the instructions, then leave them to discuss their results for a few minutes. Then the instructor wraps up that segment of labor with a brief review of important points, then goes on to next game action.

Game Action Group Discusses Instructor Could Add
Labor begins: Each team rolls 2 dice and add them together to figure out what time labor starts, then flip coin to decide if it’s a.m. (heads) or p.m. (tails) Have each small group discuss amongst themselves what symptoms she has that tells her labor is beginning, where the birthing parent might be at this time of day, where the partner might be, and how they would respond to labor if it began at that time and place. (i.e. call partner, try to rest if it’s night-time, be active if it’s morning, etc.) A review of the signs of the onset of labor.
Length of early labor: Roll 3 (or 4) dice to figure out how long early labor lasts (from 3 – 18 or 4 – 24 hours). [Multips get to roll just two dice] Teams then discuss how they would cope with that length of early labor, what moms should do to take care of themselves, and what partners should do to take care of her and themselves. Instructor reviews and reinforces options for early labor coping: resting, eating, natural augmentation.
Shift to active labor: tell them to “do the math: look at what time the labor started, then add the length of early labor to figure out what time you shift into active labor, and go to the hospital.” They discuss what it might feel like to go to the hospital at that time of day. Would traffic be an issue? Would they know how to get into the hospital in the middle of the night? Instructor could review recommendations for when to go to hospital. Could talk about hospital procedures, like where to park, and what to expect in triage.
Length of active labor: roll 2 dice to figure out how long active labor and transition are (2-12 hours) [Multips roll one die] They discuss coping skills for active labor and transition. Optional: tell everyone higher than 6 or 8 hours that dr. recommends Pitocin and/or AROM. Could review risks/benefits/alternatives.
Could address pain med options if prolonged.
Pushing Begins: “Do the math. If active labor started at x time, then add the length of active labor. What time is it?” Could touch on staffing. Is doctor likely to be in-house / nearby?
Length of pushing: roll one die, divide in half to get number of hours of pushing.
[Multips use one die, divide by 3]
Discuss how they would cope, what they could do in terms of positions, comfort, etc. Optional. If someone rolls a one, tell them their dr. didn’t make it in time, another doctor delivered baby. If they roll a 6 (3 hours), dr. recommends vacuum or forceps.
Time of Birth: Do the math. Where are friends/family members? Who will you call? Instructor could touch on the importance of spending some time in skin-to-skin contact with baby and bonding with baby in first hour…. Maybe waiting a little while to make those phone calls.
Total Length of Labor Discuss: How would that be for you? Point out that it probably didn’t HURT the whole time… but built up gradually, as contractions got longer, stronger, and closer together.

After this, tape all three sheets of paper up together in the front of the room for comparison sake, and discuss what the emotional and physical experiences might be for women who experienced this sort of labor.