Prolonged Labor: What it Is and What You Should Know

Prolonged Labor: What It Is and What You Should Know

Navigating the journey of childbirth comes with many questions and, sometimes, anxieties. One topic that can cause concern is the possibility of a labor that lasts longer than expected. Understanding what prolonged labor is, why it might happen, and how it’s managed can help you feel more prepared and informed. This guide is here to provide clear, calm, and supportive information about the experience.

Defining Prolonged Labor: What Does It Mean?

The term "prolonged labor," sometimes called "failure to progress," doesn’t have a single, one-size-fits-all definition. Instead, healthcare providers define prolonged labor based on the specific stage of labor you are in and whether this is your first birth or a subsequent one.

The process is generally divided into distinct phases, and "prolonged" means something different in each one.

Understanding the Stages of Labor

To understand the definition, it’s helpful to know the basic stages:

• Latent Phase: This is the very early part of the first stage of labor. Contractions are typically mild and irregular, and the cervix begins to soften, thin out (efface), and open (dilate) to about 6 centimeters.
• Active Phase: This is the more intense part of the first stage of labor. Contractions become stronger, longer, and more regular as the cervix dilates from 6 centimeters to its full 10 centimeters.
• Second Stage: This is the "pushing" stage, which begins after the cervix is fully dilated and ends with the birth of your baby.

The table below outlines the generally accepted medical guidelines used to define prolonged labor.

Stage of Labor	For a First-Time Parent, It May Be Considered Prolonged if It Lasts:	For a Parent Who Has Given Birth Before, It May Be Considered Prolonged if It Lasts:
Latent Phase	More than 20 hours	More than 14 hours
Active Phase	More than 12 hours (or if the cervix dilates slower than ~1 cm/hour)	More than 10 hours (or if the cervix dilates slower than ~1.2 cm/hour)
Second Stage (Pushing)	More than 3 hours (4 hours with an epidural)	More than 2 hours (3 hours with an epidural)

It’s important to remember that these are guidelines, not rigid rules. Your care team will assess your unique situation, considering your health, your baby’s health, and your overall progress.

What Causes Prolonged Labor?

There isn’t always a single, clear reason for labor to slow down. Often, it’s a combination of factors related to the three "P’s" of childbirth: Power, Passenger, and Passage.

• Power (The Contractions): Uterine contractions may not be strong or frequent enough to effectively dilate the cervix or help the baby descend. This can be due to maternal exhaustion or the effects of certain pain medications.
• Passenger (The Baby): The baby’s size or position can make the journey more difficult.
  • Position: An ideal position is head-down, facing your back (occiput anterior). If the baby is facing your abdomen ("sunny-side up" or occiput posterior) or is in a breech (feet-first) position, it can be harder for their head to engage with the cervix.
  • Size: In rare cases, the baby’s head may be too large to fit through the parent’s pelvis, a condition known as cephalopelvic disproportion (CPD).
• Passage (The Pelvis and Birth Canal): The shape or size of the birthing parent’s pelvis might make it more challenging for the baby to navigate the birth canal.
• Other Factors:
  • Psychological Stress: Fear, anxiety, and stress can release hormones that may interfere with the hormones needed for effective labor, like oxytocin.
  • Dehydration or Exhaustion: Labor is a marathon, and not having enough energy or fluids can cause contractions to weaken.

Potential Risks and Complications

When labor is prolonged, your healthcare team will monitor you and your baby very closely to manage any potential risks. While it can be worrying to think about, being aware helps you understand why certain interventions may be suggested.

For the Birthing Parent

• Physical and Emotional Exhaustion: A very long labor can be physically draining and emotionally distressing.
• Increased Risk of Infection: The longer the amniotic sac ("waters") has been broken, the higher the risk of an infection developing in the uterus.
• Higher Chance of Intervention: A prolonged labor may increase the likelihood of needing medical assistance, such as an assisted delivery or a Cesarean section.

For the Baby

• Fetal Distress: The baby may show signs of stress, such as changes in their heart rate pattern, due to the extended duration of contractions.
• Low Oxygen Levels: In some cases, a very long and difficult labor can affect the baby’s oxygen supply.
• Increased Risk of Infection: If the birthing parent develops an infection, it can also affect the baby.

How Is Prolonged Labor Managed?

If your labor is progressing slowly, your care team will first assess the situation to understand why. Their goal is to ensure both you and your baby remain safe and healthy. Management strategies range from simple comfort measures to medical interventions.

1. Close Monitoring: The first step is always careful observation. Your team will monitor your contractions, your vital signs (blood pressure, temperature), and your baby’s heart rate to ensure everyone is coping well.

2. Comfort and Support Measures: Sometimes, all that’s needed is a little help to get things moving again.

   • Changing Positions: Moving around, walking, or trying different positions (like on all fours or using a birthing ball) can use gravity to your advantage and help the baby get into a better position.
   • Rest and Hydration: If you are in the latent phase, your provider may recommend rest and fluids to help you conserve energy for the active phase.
   • Relaxation: A calm environment, a massage from a support person, or a warm shower can help reduce stress hormones and allow your body to labor more effectively.

3. Medical Interventions: If comfort measures aren’t enough, your provider may suggest one of the following:

   • Amniotomy (Breaking Your Water): If your amniotic sac is still intact, your provider may rupture it with a small, sterile hook. This can sometimes strengthen contractions and speed up labor.
   • Medication to Augment Labor: A synthetic form of the hormone oxytocin (often known by the brand names Pitocin or Syntocinon) can be given through an IV to help make your contractions stronger and more regular.
   • Assisted Delivery: If you are in the second stage and pushing is not progressing, your provider might use tools like a vacuum extractor or forceps to help guide the baby out.
   • Cesarean Section (C-section): If other methods are not successful or if there are signs of distress in you or the baby, a C-section may be recommended as the safest way to deliver.

Coping with the Emotional and Physical Experience

A labor that doesn’t go according to plan can be challenging. It’s completely normal to feel frustrated, disappointed, or exhausted. Remember to be kind to yourself.

• Communicate Openly: Talk to your doctor, midwife, and nurses. Ask questions about what is happening and what your options are. Feeling informed can restore a sense of control.
• Lean on Your Support System: Your partner, doula, or family member is there for you. Let them know what you need, whether it’s a hand to hold, words of encouragement, or just quiet presence.
• Focus on the Present: Try not to worry about how many hours have passed. Focus on getting through one contraction at a time. Your body is doing incredible work.
• Remember It Is Not Your Fault: Prolonged labor is a medical situation, not a reflection of your strength or ability. Your body and your baby are on a unique journey, and your only job is to work with your team to navigate it safely.

Navigating childbirth isn’t always easy, but hopefully, you feel more informed about prolonged labor now! Remember, talking openly with your healthcare provider is key, especially if you’re worried about how to define prolonged labor in your own circumstances. Best of luck on your journey!