Prolonged labor is one in which the combined duration of the first and second stage of labor is more than the arbitrary time limit of 20 hours.
Labor is a process that can take anywhere from a few hours to a few days. For some women, the labor process goes smoothly and they give birth relatively quickly.
For other women, labor can be prolonged, meaning it takes longer than expected for the baby to come out. This can be scary and confusing for the mother-to-be, her partner, and her support team. In this blog post, we will discuss what prolonged labor is, what to expect during it, and how to deal with it.
What is prolonged labor?
Prolonged labor is when the active phase of labor (the time from when contractions start until the baby is born) lasts more than 20 hours for first-time mothers or more than 14 hours for mothers who have given birth before.
It can also be diagnosed if your cervix has dilated less than 1 cm per hour during the active phase of labor. Prolonged labor is also referred to as “failure to progress” or “arrest of descent.”
What causes prolonged labor?
Many factors could be responsible for the prolonged labor:
- Fault in power: Abnormal uterine contractions that are too weak to push the baby down effectively.
- Fault in passenger: If the baby is positioned awkwardly or is larger than average, this can make it more difficult for them to pass through the birth canal.
- Fault in the passage: If the birth canal is narrower than normal or if the cervix opens too slowly.
- Another possibility is that the mother has an infection or a medical condition that is causing labor to be prolonged.
What are the factors that can increase the risk of prolonged labor?
- If you have gestational diabetes or pregnancy hypertension, your baby may be larger than normal.
- If you are carrying twins, triplets, or more (multiple pregnancy), it is more likely that you will experience prolonged labor.
- Prolonged labors are more common in first-time mothers.
- Advanced maternal age or extremely low maternal age.
- If you have had a cesarean section (C-section) in the past.
- If your baby is in the breech position (bottom down).
What are the signs and symptoms of prolonged labor?
The most common symptom of prolonged labor is that contractions are not strong enough to open the cervix, or they may stop altogether.
Other symptoms may include:
- Excessive tiredness
- Nausea and vomiting
- High pulse rate
- Dehydration or mouth dryness
- Increased back pain
- Decreased or no fetal movement
- Fluid leakage
- Abnormal heart rate of baby
The most common sign of prolonged labor is that contractions continue without progressing to the next stage of labor. Other signs that labor may be prolonged include:
- The cervix dilates less than one centimeter per hour during the active phase of labor
- Contractions that do not grow stronger, closer together, or last longer over time
- A decrease in the frequency of contractions
- A feeling of pressure in the rectum or vagina that does not go away
What are the risks of prolonged labor?
Prolonged labor can be associated with several risks for both the mother and baby. There are a few fetal risks associated with prolonged labor include
- Hypoxia (low oxygen levels in tissues)
- The baby could become distressed
- A heart rate that is too high or too low
- Intracranial hemorrhage
- Stillbirth
The mother could also become exhausted and her cervix could start to swell, which could make it more difficult for the baby to descend. There is also an increased risk of
- Postpartum hemorrhage
- Intrauterine infection
- Injury to the genital tract
- The placenta could detach from the uterine wall
- Rupture uterus
- Puerperal sepsis
- Subinvolution
- Increased operative delivery
How is prolonged labor treated?
Detection of the factors likely to produce prolonged labor. This can be done with a pelvic exam, ultrasound, or X-ray.
- Cesarean section is recommended if the pelvis is too small, the baby is in distress, or not in the correct position.
- If the cervix is not opening normally or contractions are not strong enough, the doctor may recommend using Pitocin to stimulate contractions or break the water.
Labor pains can be induced to help the uterus push harder. The position of the mother may be altered to make childbirth go more smoothly. A partogram can be used to record all observations.
The baby’s heart rate should be checked, and the mother should be adequately hydrated. If certain difficulties arise during labor, such as the baby’s head being too large to fit through the birth canal, an episiotomy (a surgical incision made in the perineum to enlarge the vaginal opening) and use of ventouse may be necessary.
What should you do if you are in prolonged labor?
If you think you may be in prolonged labor, it is important to contact your healthcare provider. They will be able to help you determine if you are in labor and, if so, how to proceed.
Treatment for prolonged labor will vary depending on the individual situation but may include:
- Stimulating contractions with medication
- Breaking the water
- Changing positions
- Using a vacuum or forceps to assist with delivery
- Undergoing a cesarean section
If you are in prolonged labor, it is important to stay calm and follow your healthcare provider’s instructions. Prolonged labor can be frustrating and exhausting, but it is important to remember that it is usually not harmful to either you or your baby. With the help of your healthcare team, you will be able to get through it.
What are some tips for managing prolonged labor?
There are a few things you can do to help manage prolonged labor and make it more bearable:
- Stay hydrated. Drink plenty of fluids and avoid caffeine.
- Eat small, frequent meals.
- Rest when you can. Take breaks between contractions to relax and rest.
- Try different positions. Walking, sitting, or lying down may help ease the pain of contractions.
- Use relaxation techniques. Try deep breathing, visualization, or massage.
- Talk to your healthcare provider. They can provide support and guidance throughout labor.
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