Prolonged labor, also known as failure to progress, occurs when labor lasts 20 hours or more for the first time and 14 hours or more if you’ve given birth before.
The process of childbirth is a series of intense and intermittent muscle contractions that cause the cervix and pelvic bones to open and the fetus from the uterus to enter the birth canal in the pelvis and finally exit the vagina. All stages of labor, from the beginning of contractions, are associated with pain, which can have different degrees.
Labor that progresses slowly is known as prolonged or non-progressing labor. It may happen in the first or second stage of labor. You may labor for many hours without going to the next stage. The goal of prolonged labor treatment is to keep you and your baby healthy and help you deliver your baby safely.
Normal labor process
Giving birth is a unique experience for women, both for the first time and for the second time. After the “heavy pregnancy” stage, pregnant women enter the “painful labor” stage.
Normal labor begins with short uterine contractions that last about 10 to 15 seconds and often reach 10 minutes of contractions. These contractions usually cause mild pain. Closer to delivery, uterine contractions last about 15 to 20 seconds, then 20 to 30 seconds, and when the contractions last about 30 to 40 seconds, the baby is about to be born. The occurrence of contractions is also more, three contractions in 10 minutes, and when 10 minutes are more than three contractions, and when the mother has severe abdominal pain, it is time to push the baby.
Therefore, childbirth consists of a series of intense and repeated contractions of the uterus. Contractions help push the baby out of the uterus and into the birth canal. You will probably feel contractions in your lower back and abdomen. This is called labor pain. Contractions help to widen the opening of the vagina. This allows the baby to leave your body and be born. First-time moms usually go into labor an average of 12 to 18 hours after the first contractions appear. If you’ve had a baby before, labor usually goes faster in about half that time.
How many hours of labor is considered?
Twenty-five hours or more for those who have their first baby. Twenty hours or more for those who have had at least one baby in the past. Normal births average 12 to 24 hours for the first birth and 8 to 10 hours for subsequent births.
What happens if labor goes too slowly?
When labor progresses slowly, it can lead to various concerns for both mother and baby. Some of the possible problems are:
- Fatigue: Prolonged labor can lead to extreme fatigue for the mother, making the process more physically and mentally challenging.
- Increased risk of infection: The longer the labor, the greater the risk of infection because the amniotic sac remains ruptured for a long time, providing a potential entry point for bacteria.
- Discomfort for the baby: If labor is prolonged, the baby may suffer from oxygen deprivation or other complications associated with prolonged labor.
- Medical interventions: Health care providers may intervene using medical techniques such as oxytocin to stimulate contractions, or they may consider cesarean delivery if progress is unsatisfactory and poses risks to the mother or baby.
- Emotional impact: Prolonged labor can affect a mother’s mental and emotional health, potentially affecting her birth experience.
Healthcare providers need to monitor the progress of labor and assess the health of the mother and baby regularly to make informed decisions about interventions and ensure the safest possible outcome for both.
What are the causes of prolonged labor?
Several factors can contribute to prolonged labor. These factors can be divided into three main categories: fetal factors, maternal factors, and medical interventions.
Fetal factors
Fetal malpresentation is when the baby is in an abnormal position, such as a breech or transverse lie. This can make it difficult for the baby to move through the birth canal.
- Large fetal size: If the baby is too large, it may not be able to fit through the birth canal, even if it is in the correct position.
- Multiple pregnancy: Labor is more likely prolonged if you carry twins or triplets. This is because there are more babies to deliver, which can increase the risk of complications.
Maternal factors
Weak uterine contractions: If your contractions are not strong enough or are not occurring regularly, they may not be able to dilate your cervix and push the baby out effectively.
- Cephalopelvic disproportion (CPD): This is when the baby’s head is too large to fit through the mother’s pelvis. This can be caused by several factors, including the mother’s small pelvis, the baby’s large head, or a combination of both.
- Previous cesarean section: Women who have had previous cesarean sections are more likely to have prolonged labor in subsequent pregnancies. This is because the scar tissue from the cesarean section can make it difficult for the uterus to contract effectively.
Medical interventions
- Early amniotomy: This is when the amniotic sac is broken before labor has started or has progressed significantly. This can sometimes lead to prolonged labor, especially if the membranes are not completely ruptured.
- Electronic fetal monitoring (EFM): EFM uses electronic devices to monitor the baby’s heart rate and the strength of uterine contractions. While EFM can help detect fetal distress, it can sometimes lead to unnecessary interventions, such as induction of labor or cesarean section, which can increase the risk of prolonged labor.
Risks of prolonged labor
Prolonged labor increases the possibility of needing a cesarean section. Prolonged labor can be dangerous for the baby. It may cause:
- Low oxygen levels for the baby
- Abnormal heart rhythm in a baby
- Abnormal substances in amniotic fluid
- Uterine infection
If the baby is in distress, you will need an emergency delivery. This is when close monitoring is important for the health of mother and child.
Factors that can increase the risk of prolonged labor
The most important factors that can increase the risk of prolonged labor.
Obesity
Gestational diabetes or gestational hypertension with obesity can increase the size of the baby above average. Such health complications can weaken the mother, and fat around the birth canal can cause problems.
Being too thin
Lack of nutrition in the mother leads to a lack of nutrition in the fetus and uterus. Hence, it is important to take care of being fit and strong. Sometimes, a small size can indicate a small pelvis and may delay the baby’s birth.
Decrease in muscle mass
One of the reasons for the decrease in muscle mass in pregnant women is the lack of exercise and movement. Childbirth is a very active and exhausting procedure for the body, and it requires good muscle function for mental development. Reduced muscle mass reduces strength and increases the risk of slow labor.
Advanced maternal age or very low maternal age
The most suitable age for easy childbirth is late teens to early thirties. A very young body does not expect to give birth and, therefore, is not sufficiently or strongly prepared for childbirth. First-time mothers at an advanced age must be in good physical shape; otherwise, they face health complications such as gestational diabetes.
How is prolonged labor treated?
The treatment for prolonged labor will depend on the individual circumstances, but it typically involves a combination of monitoring, medical interventions, and supportive care. The goal of treatment is to deliver the baby as quickly and safely as possible while minimizing the risk of complications for both the mother and the baby.
Monitoring
Your healthcare provider will closely monitor your labor progress and your baby’s well-being. This will include regular checks of your cervix, your contractions, and your baby’s heart rate. If there are concerns about your baby’s well-being, your healthcare provider may recommend additional monitoring, such as continuous fetal monitoring or ultrasound.
Medical interventions
If your labor is not progressing despite monitoring and supportive care, your healthcare provider may recommend one or more medical interventions. These interventions may include:
- Oxytocin: This medication is used to strengthen and regulate contractions.
- Amniotomy: Amniotomy is the amniotic sac rupture, which can sometimes help speed up labor.
- Forceps or vacuum extraction: These devices can assist in delivering the baby if the baby is in distress or if the mother is too tired to push effectively.
- Cesarean section: This is a major surgery that is performed to deliver the baby if other methods are unsuccessful or if there are concerns about the safety of the mother or the baby.
Supportive care
In addition to medical interventions, your healthcare provider will provide supportive care to help you manage the pain of labor and stay comfortable. This may include pain medication, relaxation techniques, and emotional support. Prolonged labor can be a difficult and stressful experience for both the mother and the baby. However, with proper care and monitoring, the vast majority of women who experience prolonged labor have healthy babies.
Here are some tips for coping with prolonged labor:
- Stay calm and relaxed. This will help to keep your contractions strong and regular.
- Move around and change positions. This can help to change the baby’s position and make it easier for him or her to descend into the birth canal.
- Get plenty of rest. This will help to conserve your energy for labor.
- Eat healthy foods and stay hydrated. This will help to keep your energy levels up and your body functioning properly.
- Have someone with you for support. This could be your partner, a friend, or a family member.
Talk to your doctor about your concerns. Your doctor can answer your questions and help you to feel more confident about your labor.
The bottom line
Prolonged labor, also known as failure to progress, is a labor that lasts longer than expected. It can be caused by a variety of factors, including fetal malpresentation, large fetal size, multiple pregnancy, weak uterine contractions, cephalopelvic disproportion (CPD), previous cesarean section, early amniotomy, and electronic fetal monitoring (EFM).
Treatment for prolonged labor typically involves a combination of monitoring, medical interventions, and supportive care. The goal is to deliver the baby as quickly and safely as possible while minimizing the risk of complications for both the mother and the baby.
Prolonged labor can be a difficult and stressful experience, but with proper care and monitoring, the vast majority of women who experience prolonged labor have healthy babies.
Additional questions
- What is a birth canal?
A channel formed by the cervix, vagina, and vulva through which the fetus passes during birth.
- What is oxytocin?
Oxytocin is a naturally occurring hormone that regulates key aspects of the male and female reproductive system, including labor, delivery, lactation, and human behavior.
- What is the forceps delivery method?
Forceps are flat metal tools that look like spoons or large tongs. They are curved to fit around the baby’s head. The forceps are placed around the child’s head and connected in bundles. With a contraction and push from the mother, an obstetrician gently pulls to assist in the delivery.
- What position should the fetus be in for delivery?
In cephalic manifestations, the baby is head down, chin to chest, and facing the mother’s back. This position typically allows for the smoothest birth, as the baby’s head can easily move through the birth canal and under the pubic bone during labor.
- What causes a uterine infection?
When bacteria from the vagina or cervix travel to the uterus, fallopian tubes, or ovaries, they can cause an infection. Most often, PID is caused by chlamydia and gonorrhea bacteria. These are sexually transmitted infections (STIs). Having unprotected sex with someone who has an STI can cause PID.
References
https://my.clevelandclinic.org/health/diseases/24752-prolonged-labor
https://www.webmd.com/baby/prolonged-labor-causes-treatments
https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/prolonged-labor/
https://parenting.firstcry.com/articles/prolonged-labour-causes-signs-and-treatment/
https://beasleyfirm.com/blog/what-are-the-risks-of-prolonged-labor/