Labour is considered normal when uterine contractions result in progressive dilation and effacement (stretching and thinning) of the cervix. Normal labor progresses slowly through the initial phase and then, when the cervix is dilated more than four centimeters, the more rapid, active phase of labor begins. If some of the markers for progress during labour are delayed or stalled, your doctor or midwife must evaluate whether there is “prolonged” or “arrested” labor.
If there is, he/she may try a number of different interventions to assist with a vaginal birth. However, because of the health risks for both the mother and child, including oxygen deprivation, permanent injury, and trauma in the child, and hemorrhaging and infection in the mother, allowing a labour to continue for too long is not an option.
Typically, if initial attempts to intervene are unsuccessful, your doctor will prepare to carry out a C-section delivery in order to keep you and your baby out of harm’s way.
What Is Prolonged Labour?
Simply put, prolonged labour is the inability of a woman to proceed with childbirth upon going into labor. In more elaborate terms however, the cervix of a woman in active labour should progressively dilate at a rate of no less than 1.2 cm per hour (during first pregnancy) or 1.5 cm per hour (for subsequent pregnancies). If labor progresses more slowly than this, she may be experiencing arrested or prolonged labor.
Causes Of Prolonged Labour
Prolongation and arrest of labor are primarily due to conditions that cause inadequate contractions. Listed below are complications that can lead to prolonged and arrested labor:
- Fetal malpresentation: If the baby is not in the cephalic (vertex) position (in which the head is at the lower part of the abdomen) before birth, issues with labor progression can occur.
- Cephalopelvic disproportion (CPD): CPD occurs when there is disproportion between the size of the fetus and the size of the maternal pelvis. This size mismatch can cause labor to slow or stop completely.
- Problems with uterine contractions: Inadequate uterine activity occurs when contractions are either not sufficiently strong or not appropriately coordinated enough to dilate the cervix and push the baby out. Issues with uterine activity can arise due to a pregnancy with multiples, excessive use of painkillers or anesthesia, or a variety of other factors.
- Maternal obesity: Higher maternal BMI (body mass index) is correlated with a longer first stage of labor, as well as a variety of other pregnancy complications.
Signs and symptoms of arrested or prolonged labor include the following:
- Labor that extends for more than 14 – 20 hours
- Maternal exhaustion and/or distress; dehydration may be present, and the mouth may be dry due to prolonged mouth breathing
- Pain in the back and sides of the body, radiating out to the thighs due to prolonged strong pressure on the back
- Decrease in labor pains over time as the muscles become fatigued
- High pulse rate due to dehydration, exhaustion, and stress
- Dilation of the large intestines, which can be felt along both sides of the uterus as large, thick, air-filled structures
- The uterus is tender upon touch and does not relax fully between contractions
- Fetal distress may develop
- Abnormal contraction patterns which may include “coupling” (two contractions in rapid succession) or “tripling” (three contractions in rapid succession)
Managing Prolonged Labour
In managing the situation, your doctor’s interventions are geared towards helping you safely deliver your baby. Below are the options that he/she may consider in assisting you to safely welcome your baby:
- Administer a synthetic hormone, pitocin/Oxytocin to induce labour and strengthen uterine contractions.
- Amniotomy: This is the artificial rupture of the amniotic membrane in order to accelerate labour.
- Your doctor may turn to forceps and vacuum extractors to assist in case of vaginal delivery.
- Lastly, a ceaserean section when the doctor has determined that a vaginal delivery would put the baby or mother at risk.