Prolonged Labour – Causes, Signs and Treatment

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Dr. Sabiha Anjum (Obstetrician and Gynaecologist )
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Prolonged Labour - Causes, Signs and Treatment

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The closer D-day gets, the lower is your patience level! There is excitement, happiness, and incredible restlessness to meet the little one. Therefore, the thought of the birth being delayed, prolonged or obstructed can be quite emotionally disheartening.

Prolonged labour can cause serious harm to the baby or the mother, and may be life-threatening. Read on below to explore what it is, and how it can affect you.

What Is Prolonged Labour?

Prolonged labour is also known as failure to progress, or slow progress of labour. When the duration of labour is abnormally long, it is bracketed as prolonged labour. Prolonged labour has no definite definition as at different stages, the delay differs, and the causes also differ.

  • Prolonged Early Stage of Labour: When labour is prolonged for more than 8 hours without progressing to the first stage.
  • Prolonged First Stage of Labour: When is labour prolonged for more than 12 hours without progressing to the second stage.
  • Prolonged Second Stage of Labour: This usually takes five to thirty minutes. But it is prolonged if it is:
    • 2-3 hours for a woman who has been pregnant before.
    • 1-2 hours for a woman who is pregnant for the first time.

So, one is in prolonged labour if the labour lasts more than 20 hours; if it is twins or multiples, then prolonged labour is declared at 16 hours.

What Are the Causes of Prolonged Labour?

The causes of prolonged labour occur at physical, emotional, and social levels. But three principal causes are the 3 Ps: passage, passenger, and power.

1. Obstructed Labour (Passage)

When the pelvis of the mother is too small, or the passage through which the baby is to come out is small for the baby’s head to pass through, the labour is prolonged. Rarely, an unusually shaped pelvis or some other obstruction in the passage, such as a tumour, will lead to prolonged labour.

2. Foetal Factors (Passenger)

The causes of prolonged labour due to the ‘passenger’ or the foetus can be that the foetus continues to grow even after the due date, it is too big, or that the head is too big to pass through the pelvis.

3. Weak Contractions (Power)

One of the major causes of prolonged labour is lack of power in contractions. The contractions are not strong enough to induce the pushes for delivery.

Tired woman in labour

Signs and Symptoms of Prolonged Labour

Signs and symptoms of prolonged labour include:

  • Labour beyond 18 hours: The most prominent sign is the delay.
  • Maternal exhaustion: The mother is feeling weak and fatigued.
  • Other physical symptoms such as unbearable back pain, high pulse rate, and a tender uterus also warn of a prolonged labour.
  • Ketosis: This is a complication of dehydration, and a lack of carbohydrates (or glucose) for energy in the body, which results in abnormal accumulation of ketone bodies.

Factors That Can Increase the Risk of Prolonged Labour

1. Obesity

Gestational diabetes, or pregnancy hypertension accompanied by obesity can increase the size of the baby from the average. Such health complications can make the mother weak, and the fat around the birth canal can cause problems.

2. Being Too Skinny

Lack of nutrition in the mother leads to lack of nutrition in the foetus and the uterus, causing complications to the passage, passenger, and power (explained above). Hence, it is important to take care to be fit and strong. Sometimes, a small body can indicate a small pelvis, and that might delay the baby’s arrival.

3. Decrease in Muscle Mass

One of the causes for the decrease of muscle mass in a pregnant woman is lack of exercise and activity. Labour is a very active and strenuous procedure for the body, and it requires good muscle function for smooth progress. A decrease in muscle mass will reduce strength, increasing the risk of slow or prolonged labour.

4. Advanced Maternal Age or Very Low Maternal Age

The most convenient age for the body to give birth smoothly is the late teens to the early thirties. Anything before or after is a time that the body is not prepared. A very young body is not anticipating a birth, and hence is not prepared or strong enough to give birth. Mothers giving birth for the first time at an advanced age need to be extremely fit, or they face health complications such as gestational diabetes.

What Happens if Your Labour Seems to Be Going Too Slowly?

  • In the face of slow progress, the only way through this is to stay as calm as possible.
  • One of the immediate things done when prolonged labour is recognised is to relax the mother emotionally and mentally through the presence of a strong companion, pain relief, or any other element which may de-stress the mother.
  • One may be given natural or pharmacological pain relief.
  • The medical team will closely monitor the 3 Ps (passage, passenger, and power) to understand and take necessary actions to quicken the progress. This includes tests like continuous foetal monitoring to check the baby’s heart rate. An IUPC (Intrauterine Pressure Catheter) to check the power of contractions may also be used.

Woman in prolonged labour

Complications of Prolonged Labour

Prolonged labour can cause serious complications in the mother or the baby, and can even be fatal. However, advanced technology and science have reduced such complications.

Some common complications in the mother include:

Problems for the baby include:

  • Infection
  • Asphyxia (reduced oxygen to the baby) and traumatic injury
  • Stillbirth

How Is Prolonged Labour Treated?

The treatment or solution is appropriate prolonged labour management. This is a medical term that means precautions taken by the health team to reduce the slow progress of labour.

  • Early detection of certain problems with the 3 Ps and the health of the mother, during the 3 trimesters, will help in progressing towards better fitness.
  • Detecting true labour from false labour is one of the first precautions to be observed, so as to not induce unnecessary pain and stress.
  • Labour pains can be induced to increase the power of the uterus to push.
  • Change in the positioning of the mother can improve the procedure of giving birth more efficiently.
  • A partogram can be used to record all observations.
  • Baby’s heart rate should be monitored, and the mother should be hydrated enough to empty the bladder every two hours.
  • If certain complications do arise during natural labour, usage of vacuum extraction to pull out the baby could be used.
  • The final solution would be a C-section. The doctor might even advice and prepare you during the trimesters for the same.

How to Reduce the Risk of Having Prolonged Labour

The risk of failure to progress, or slow progress of labour, can be drastically reduced by the following precautions:

  • Healthy lifestyle: To stay fit and active, take care of yourself  by maintaining a healthy diet and sticking to an exercise regime.
  • Stay stress-free: Think about how happy you will be to have your baby in your arms! Block out any fears in your heart by trying to think of positive thoughts, and surrounding yourself with light and positive activities and energy.

A poor lifestyle is one of the main causes of complications during labour. It is recommended that you schedule regular check-ups with your gynaecologist/obstetrician, so that issues like obesity or low muscle mass can be spotted early. By adopting the right approaches, you can minimise prolonged labour.

Also Read: Stages of Labour and Delivery

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