When you are expecting a baby, your greatest hope is to bring a healthy little one into the world. However, sometimes labor can last longer than you anticipated. We call this 'Prolonged Labor'. While this term might sound a bit frightening, understanding it completely can help ease your anxiety.
What is Prolonged Labor?
Simply put, prolonged labor refers to a childbirth process that takes longer than average. Some mothers experience contractions for many hours without being able to progress to the next stage of birth. During such times, our primary goal as healthcare providers at Nirogi Lanka is to ensure both you and your baby stay healthy and deliver safely.
How many hours define prolonged labor?
Generally,
- For first-time mothers, if labor lasts 25 hours or longer,
- For mothers who have given birth before, if labor lasts 20 hours or longer,
we consider it a case of prolonged labor.
Think of it this way: a typical first labor usually lasts between 12 and 24 hours, while subsequent deliveries typically take about 8 to 10 hours. If your labor extends beyond these standard timeframes, we focus on managing this specific condition.
What happens during prolonged labor?
During this time, two main issues typically occur:
1. Your cervix stops opening (dilating) before it reaches the full 10 centimeters required for birth. The cervix is the lower part of your uterus that opens during labor.
2. Alternatively, even after the cervix has fully opened, the baby stops moving down the birth canal.
How common is this condition?
Prolonged labor is actually not very common. Only about 8% of pregnancies face this situation. However, it is a leading factor in about one-third of all C-section procedures.
What are the risks associated with prolonged labor?
Failure to progress during the first stage of labor rarely causes major complications, though it can leave you feeling physically and mentally exhausted. However, if labor is prolonged during the second stage, it can become more serious and increase the risk of:
- Infection.
- Postpartum hemorrhage (excessive bleeding after birth).
- Future issues with urinary incontinence.
- Future risk of pelvic organ prolapse.
- Uterine rupture (though this is extremely rare).
When labor is prolonged, you are more likely to require medical intervention. For example, your doctor may need to use tools like a vacuum or forceps to assist the baby out. It also increases the likelihood of requiring a C-section.
Can prolonged labor affect the baby?
Yes, this condition can pose certain risks to the baby, including:
- Infections (often transmitted from mother to baby).
- Fetal distress, such as decreased heart rate.
- Perinatal asphyxia (oxygen deprivation at birth).
- Shoulder dystocia (the baby’s shoulder getting stuck in the birth canal).
What causes labor to become prolonged?
As you know, there are two stages of labor. The first stage is from the onset of uterine contractions until the cervix is fully dilated. The second stage is from full dilation until the baby is born.
In the first stage, your cervix thins out (effacement). If this process is slow, the total duration increases. The main cause is often insufficient uterine contractions. Sometimes, pain-relief medications like morphine given early in labor can weaken these contractions and delay progress.
The second stage is considered prolonged if it lasts more than 3 to 4 hours for a first-time mother, or more than 2 to 3 hours for someone who has delivered before.
Common factors in the second stage include:
- A larger-than-average baby.
- A narrow birth canal.
- Your pelvis may not be large enough for the baby to descend easily.
- Uterine contractions that are not strong enough.
Additionally, research has shown that psychological factors such as anxiety, stress, and fear during labor can also contribute to the process taking longer.
What about smoking and epidurals?
Can smoking delay labor?
While smoking isn't a direct cause of prolonged labor, some studies suggest that smokers have a higher risk of experiencing it compared to non-smokers. One study showed a higher rate of C-sections among those who smoke. Therefore, doctors at Nirogi Lanka recommend quitting smoking before pregnancy, as it can cause significant health problems for both you and your baby.
Does an epidural prolong labor?
No. There is no direct link between receiving an epidural and prolonged labor. In fact, there is evidence that an epidural can help relax you, potentially even speeding up the first stage of labor.
How do I know if I am in prolonged labor?
The main sign is a lack of progress or only very minimal progress over a long period. If you are a first-time mother and labor exceeds 25 hours, or 20 hours for subsequent births, it is likely that your labor is being classified as prolonged. However, please remember that if you have induced labor, the duration might naturally be longer than spontaneous labor.
How do doctors determine if there is a 'Failure to Progress'?
Your doctor will check your cervix to assess the degree of effacement (thinning) and dilation (opening). In the first stage, your cervix needs to reach 10cm. In the second stage, the baby must descend. If you have been in labor for about 20 hours and the baby has not been born, your medical team will likely classify your labor as prolonged.
What is done if labor is prolonged?
If you face a prolonged first stage of labor, the goal is to strengthen uterine contractions to help the cervix dilate. Your doctor might recommend the following:
- If appropriate, nipple stimulation. This helps naturally increase the production of oxytocin, a hormone that strengthens uterine contractions.
- Artificial rupture of membranes (AROM), also known as an amniotomy, where your doctor intentionally breaks the fluid-filled sac.
- Administration of medications like oxytocin (Pitocin®) or other agents to help ripen and soften your cervix.
- Taking a warm bath to help you relax and stay comfortable.
During the second stage of labor, your doctor may suggest the following:
- Changing positions frequently or walking.
- Prioritizing rest and relaxation.
- Starting medications, such as oxytocin, to help progress labor.
What are the risk factors for prolonged labor?
Certain factors can increase the likelihood of experiencing a longer labor. These include:
- Multiple pregnancies, such as carrying twins or triplets.
- Fetal position, as some positions can make passage through the birth canal more challenging.
- Older maternal age.
- High Body Mass Index (BMI).
Can these risks be managed before labor begins?
Yes, some risk factors can be managed. For example, you can discuss maintaining a healthy weight throughout your pregnancy with your doctor, as a higher BMI is associated with an increased risk of prolonged labor.
During labor, even if the baby is head-down, if they are facing your abdomen (occiput posterior position), it can be difficult for them to move through the pelvis. In some cases, your doctor may be able to manually help rotate the baby into a more favorable position, making the descent easier.
However, some factors like maternal age or carrying multiples cannot be changed. Therefore, it is important to discuss your birth plan with your support person and medical team well in advance, including strategies for managing potential labor delays.
What happens if labor becomes prolonged?
Prolonged labor can be a physically, mentally, and emotionally exhausting experience. Should this occur, your medical team will monitor you closely, performing regular cervical checks and potentially recommending medications like oxytocin to encourage progress. They will also closely monitor the baby to ensure they are not showing signs of fetal distress.
During this time, your best approach is to focus on resting, lean on your support person, and try to remain as positive as possible.
What questions should I ask my doctor about prolonged labor?
While prolonged labor is not inevitable, if you believe you are at higher risk, it is helpful to have an open discussion with your doctor. Consider asking these questions:
- Am I at an increased risk for prolonged labor?
- Are there specific steps I can take to reduce this risk?
- What is my baby's current position?
- If the baby is not in an optimal position, are there ways to encourage them to turn?
- How do you typically manage prolonged labor?
- What pain management options are available to me?
Final words to remember
While labor lasting 20 hours or more can feel overwhelming, your medical team is working toward a shared goal: a safe and healthy delivery for both you and your baby. Do not hesitate to have an honest conversation with your doctor about their approach to managing labor. Never feel afraid to voice your concerns or ask questions. Remember, with Nirogi Lanka, you are never alone on this journey.
