Most women have heard stories from other pregnant women, mothers, and even their healthcare providers about prolonged labor, but may not be so sure what exactly prolonged labor is. When do we say labor is prolonged and what can we do about it? If doctors say I have prolonged labor, what must have caused it? These are common questions about prolonged labor, and in this article we provide answers to them.
Prolonged labor is the inability of a woman to proceed with childbirth after the onset of labor, and this is diagnosed after over 20 hours of labor for first time mothers, and over 14 hours for mothers who have given birth before. Labor occurs when contractions of the womb produce steady opening or dilation of the cervix, and this occurs in two phases: latent phase and active phase. Either phase could be prolonged, causing an overall prolonged labor.
Common causes of prolonged labor include:
- Reduced power of the womb: For some reasons, including overstimulation of the womb, overstretching of the womb due to multiple pregnancies, and excessive amount of anesthesia, the womb may lack the power to contract and push the baby downward. This is a very common cause of prolonged labor.
- Labor obstruction: Other times, the womb has adequate power to contract and push the baby downward, but the passage is being obstructed by something. This blockage could be from the mother herself, including a narrow pelvis or birth canal (what doctors call cephalopelvic disproportion), multiple pregnancies, first time pregnancies where the pelvic ligaments are still quite rigid, and obstructive growths in the pelvic area, such as fibroids.
- Malpositions and malpresentations: A head-down, buttock-up position of the baby is considered normal position and allows for easy descent of the baby through the birth canal. Positions where the baby lies horizontally in the womb or has a slanted position in the womb may prolong labor.
- Cervical Dystocia: Some times, the power of the womb is good, the baby is well positioned, but the cervix just won’t open up. This condition is called cervical dystocia and often occurs when the cervix, the lower end of the womb, stays rigid. This may be caused by some problems with the cervix itself or occasionally by lack of power in the womb.
Treatment of Prolonged Labor
Sometimes, doctors and midwives can identify early a woman who is likely to have prolonged labor. In this situation, preventive measures are taken fast.
- The preventive measure includes the use of medications, called oxytocin infusions, which would support the power of the womb. This is often employed when the power of the womb or slow cervical dilation seem to be the cause of prolonged labor.
In active phase of labor, when the baby has descended but is stuck in the pelvis, there are different methods of delivery. These include:
- Assisted vaginal delivery: Using forceps, a surgical tool that looks like two large salad spoons, the baby can be delivered safely when labor has passed the threshold or is getting prolonged. Assisted vaginal delivery may also involve the use of vacuum extractors to safely pull the baby out of the birth canal.
- Surgery: In cases due to obstruction or if the baby is in serious distress such that further delay may compromise the life of the baby or mother, surgical delivery via a C-section is needed.
In summary, prolonged labor is a common phenomenon in pregnancy. It could be caused by as simple as a weak contraction to obstruction in the passage of the baby. Overall, it requires some form of intervention to salvage the life of the baby and the mother.
