Is your labor also delayed? (Prolonged Labor) Let's talk about this!

When a mother is about to have a baby, one of the greatest hopes she has is to deliver a healthy baby into this world. But sometimes this labor can take a little longer than expected. This is what we call ' prolonged labor' . Hearing this can be a little scary, but knowing exactly what it is can help reduce that fear.

What is Prolonged Labor?

Simply put, prolonged labor is when the baby is born longer than normal. Some mothers are unable to continue into the next stage of labor despite hours of labor. The main goal of doctors at this time is to keep you and your baby healthy and help you deliver your baby safely.

How many hours does it take to be considered a prolonged labor?

Usually,

• For a mother expecting her first child, if it takes 25 hours or more ,
• For a mother who has had one or more children before, if it takes 20 hours or more ,

We consider it as a prolonged labor. Think about it, a first birth usually lasts between 12 and 24 hours. Subsequent births last about 8 to 10 hours. So if it lasts longer than that, we're talking about this condition.

What happens when labor is prolonged?

At this point, two main things can happen: 1. Your cervix starts to open, but stops before it reaches 10 centimeters. The cervix is ​​part of the female reproductive system. 2. Or, even though the cervix is ​​fully open, the baby stops moving down the birth canal.

How common is this condition?

Prolonged labor is actually not that common. It affects about 8% of pregnant women. However, it is responsible for about a third of all C-sections.

What are the risks of prolonged labor?

Failure to progress (Failure to Progress) in the first stage of labor is less likely to cause major complications. However, it can be mentally and physically exhausting for the mother. However, prolonged labor in the second stage of labor can be a bit more serious. It increases the risks of:

• Infection .
• Postpartum hemorrhage .
• Inability to control urine in the future (incontinence).
• Pelvic organ prolapse in the future.
• Uterine rupture (this is very rare).

As labor progresses, you are more likely to need to deliver your baby in a different way. For example, your doctor may need to use a vacuum or forceps to help deliver your baby . This also increases the chance of you having a cesarean section (C-section) .

Can prolonged labor affect the baby?

Yes, this condition can pose some risks to the baby. Some of them are:

• Infection (often transmitted from mother to baby).
• Fetal distress, such as decreased fetal heart rate .
• Lack of oxygen at birth (Perinatal asphyxia).
• Shoulder dystocia.

What are the reasons for prolonged labor?

We know that there are two stages of labor. The first stage is the time from when your uterus starts to contract until your cervix is ​​fully dilated. The second stage is the time after your cervix is ​​fully dilated until your baby is born. In the first stage , your cervix is ​​thinning (efffacement). As this thinning of the cervix occurs slowly, it can take longer for your baby to be born. The main reason for this is that your uterus is not contracting enough. Sometimes, some painkillers, such as morphine, given early in labor can weaken your uterus and delay your baby’s birth. The second stage is considered prolonged if it takes more than three to four hours for a first-time mother, and more than two to three hours for someone who has had a baby before. The following factors can cause your baby to be delayed during the second stage:

• The baby's size is increasing.
• Birth canal compression.
• Your pelvis is not large enough for the baby to descend.
• Uterine contractions not being strong enough.

Additionally, research has found that psychological factors such as anxiety, stress, and fear during labor can also contribute to prolonged labor.

Shall we also learn about smoking and epidurals?

Can smoking delay labor?

Smoking cannot be directly said to cause prolonged labor. However, some studies have shown that smokers are more likely to have prolonged labor than non-smokers.In one study, smokers were also more likely to have cesarean sections. That's why doctors recommend quitting smoking before getting pregnant. Smoking during pregnancy can cause problems for both you and your baby.

Does having an epidural delay labor?

No. There is no link between an epidural and prolonging labor. In fact, there is some evidence that an epidural can make you feel more comfortable and help speed up the first stage of labor.

How do I know if my labor is prolonged?

The main sign of prolonged labor is that each stage goes on for a long time with little or no progress. If it takes more than 25 hours for your first baby, or more than 20 hours for someone who has had a previous baby, your labor is likely prolonged. But remember, if you had an induced labor, your labor may take a little longer.

How do doctors know if labor is failing to progress?

Your doctor will determine this by examining your cervix and measuring how much it has thinned (effacement) and opened (dilation). In the first stage, your cervix should be 10 centimeters dilated. In the second stage, your baby should be moving down the birth canal. If your baby hasn't been born after about 20 hours of labor, you're probably in protracted labor.

What do you do if labor is prolonged?

If you're experiencing dilation in the first stage of labor, your doctor's goal is to help your cervix open by causing stronger uterine contractions. Your doctor may recommend the following:

• If appropriate, perform a nipple massage . This increases the body's natural production of the hormone oxytocin , which strengthens uterine contractions.
• Breaking the water bag, that is, artificial rupture of membranes (AROM) or amniotomy.
• Giving medications like oxytocin (Pitocin®) or other medications that help ripen your cervix .
• Take a warm bath to relax.

In the second stage , the doctor may suggest things like:

• Frequent changing of posture or walking.
• Resting and relaxing.
• Starting medications such as Oxytocin.

What are the risk factors for prolonged labor?

Certain factors may increase your risk of prolonged labor. Some of them include:

• Multiple pregnancies, such as twins (Carrying multiples).
• The position of the baby in the womb (some positions can make delivery difficult).
• Older maternal age.
• High Body Mass Index (BMI).

Can this risk be reduced before labor begins?

Yes, we can change some risk factors. For example, you can talk to your doctor about maintaining a healthy weight throughout your pregnancy, as having a high BMI increases your risk of having a prolonged labor. During labor, if the baby is in the occiput posterior position, even if the baby is head down, it can be difficult for the baby to pass through the pelvis. Your doctor may be able to turn the baby into the correct position, which will help the baby pass through the pelvis more easily. However, there are some factors that we cannot change, such as your age or whether you are expecting twins. Therefore, before giving birth, talk to your support person and medical team about your birth plan. It is a good idea to include the possibility of a prolonged labor and how to manage it.

What kind of experience will you face if labor is prolonged?

Prolonged labor is a physically, mentally, and emotionally draining experience. If you are experiencing this, your healthcare team will monitor your progress by checking your cervix frequently. They may also prescribe medications, such as oxytocin, to help your labor progress. They will also closely monitor your baby to identify any signs of distress.

The best thing you can do at a time like this is to rest, seek help from your support person, and stay as positive as possible.

What questions should I ask the doctor about prolonged labor?

Although prolonged labor is rare, it's a good idea to talk to your doctor about it if you're at increased risk. Some questions to ask include:

• Am I at increased risk of prolonged labor?
• Are there things I can do to reduce that risk?
• What position is my baby in?
• If the baby is not in the right position for delivery, are there ways to turn him/her?
• How do you manage prolonged labor?
• What pain management methods do you have?

Finally, things to remember

While 20 hours or more of labor may seem like a long time, your medical team is working with you toward a common goal. That is, to provide a healthy, safe delivery for both you and your baby. Talk to your doctor about their approach to prolonged labor. Don’t be afraid to talk to them about any questions or concerns you may have. Remember, you are not alone on this journey!