Labor that lasts longer than normal is referred to as prolonged labor. Typical labor for a first-time mother lasts on average between 12 to 19 hours, while for mothers who have previously given birth labor lasts between 6 to 12 hours. Labor that lasts significantly longer than these averages is considered prolonged.
What is prolonged labor?
Prolonged labor is defined as labor that lasts for more than 20 hours for first-time mothers and more than 14 hours for women who have previously given birth. Doctors may also diagnose prolonged labor if labor is progressing too slowly – less than 1-2 centimeters of cervical dilation per hour for first time mothers, and less than 2 centimeters per hour for women who have previously given birth.
What causes prolonged labor?
There are several potential causes of prolonged labor:
– Baby’s position – If the baby is in an abnormal position like breech or transverse, it may be harder for them to pass through the birth canal slowing down labor.
– Baby’s size – A very large baby, especially one over 8 pounds 13 ounces, may have more difficulty fitting through the birth canal.
– Pelvic structure – A narrow pelvic opening can make it harder for the baby to descend slowing down dilation.
– Weak contractions – Contractions that are too weak, short, or spaced far apart will not effectively dilate the cervix.
– Medical conditions – Conditions like obesity, high blood pressure, diabetes, or a small pelvis can increase the risk of prolonged labor.
– Exhaustion – Exhaustion of the mother can cause labor to stall.
– Stress – High stress levels release hormones that can interfere with labor progression.
– Epidural anesthesia – While they provide pain relief, epidurals can prolong labor especially the pushing stage.
How does prolonged labor affect the baby?
Prolonged labor that lasts more than 24 hours can increase health risks to the baby both during delivery and after birth. Some potential effects on the baby include:
Fetal distress
As labor becomes prolonged, the contractions may start to stress the baby as their oxygen supply becomes diminished. This can lead to fetal distress where the baby’s heart rate slows or becomes too fast. Fetal distress affects up to 60% of prolonged labors.
Signs of fetal distress:
– Meconium in the amniotic fluid
– Abnormal fetal heart rate patterns
– Low fetal movement
To monitor for fetal distress, doctors will monitor the baby’s heart rate throughout prolonged labor. If distress is suspected, they may recommend expedited delivery with forceps, vacuum extraction, or cesarean section.
Infection
The longer the membranes have been ruptured, the higher the risk of infection traveling up the birth canal and into the amniotic fluid. An infection in the uterus or amniotic fluid is called chorioamnionitis and can make the baby very ill. It affects about 5% of women with prolonged labor.
Signs of chorioamnionitis:
– Fever in mom >100.4°F
– Tachycardia (fast heart rate) in mom >100bpm
– Uterine tenderness
– Foul odor of amniotic fluid
– Maternal or fetal tachycardia
Chorioamnionitis is treated with antibiotics. Babies born with an infection may need observation in the NICU.
Low Apgar scores
The stress of prolonged labor can cause the baby to be born in poor condition with low Apgar scores at 1 and 5 minutes after birth. Apgar scores measure the baby’s:
– Appearance
– Pulse
– Grimace response
– Activity
– Respiration
Each area gets a score of 0-2 for a total of 0-10. Low scores under 7 indicate the baby needs medical attention at birth.
Birth injuries
Prolonged labor often leads doctors to use interventions like vacuum extraction, forceps, or episiotomies to deliver the baby faster. However, these methods can increase the risk of birth injuries such as:
– Caput – Swelling on the head from pressure against the cervix
– Cephalohematoma – Bleeding under the scalp from vacuum extraction
– Subconjunctival hemorrhage – Burst blood vessels in eyes
– Facial nerve palsy – Temporary paralysis of facial muscles
– Brachial plexus injury – Nerve damage in the neck, shoulders, arms
– Clavicle fracture
These birth injuries are usually temporary but can become permanent in some cases. The baby will need to be monitored for any signs of nerve damage or disability.
Excessive molding of the head
As the baby’s head presses against the birth canal for hours, the skull bones can overlap and cause the head to elongate. This is called molding. Excessive molding from prolonged labor can cause skull and facial deformities.
However, mild molding usually resolves in the first few days after birth as the skull bones revert to normal. Severe molding may require a helmet to correct the abnormal head shape.
Increased admission to the NICU
Due to the various risks and complications associated with prolonged labor, admission to the neonatal intensive care unit (NICU) is more common. Studies show about 25% of babies born after prolonged labors are admitted to the NICU compared to just 5-10% of babies born after normal length labors.
Effects on newborn reflexes and behavior
Some research has found that prolonged labor can impact the newborn baby’s reflexes like sucking and rooting immediately after birth. It may also make them less alert, responsive and affect their behavior in the first few days of life.
However, these effects appear short-lived in babies born in good condition. More research is still needed on potential long-term neurobehavioral effects.
Can prolonged labor cause brain damage?
While rare, there is a small risk that prolonged labor deprives the baby’s brain of oxygen long enough to cause brain cell death and permanent brain damage. However, most studies have found no link between prolonged labor and long-term adverse neurodevelopmental outcomes like cerebral palsy or cognitive impairment when confounding factors are controlled.
Some factors that can increase the small risk of brain damage during prolonged labor include:
– Chorioamnionitis
– Use of vacuum extraction or forceps
– Tight nuchal cord
– Uterine ruptures
– Severe variable decelerations in fetal heart rate
– Placental abruption
To help prevent brain damage doctors closely monitor the baby for signs of distress and intervene quickly if detected. Getting appropriate pain relief, staying hydrated, and trying to rest between contractions may also help avoid exhaustion that could affect oxygen supply.
Does prolonged labor increase the risk of stillbirth?
In most cases, prolonged labor alone does not increase the risk of stillbirth in an otherwise low-risk pregnancy. However, certain complications like an infection, placental abruption, cord complications, or severe fetal distress can be more likely with prolonged labor potentially increasing stillbirth risk.
Studies show the rate of stillbirth increases once labor exceeds 24 hours for first-time mothers and 18 hours for women who have given birth before. The rate continues to rise the longer labor lasts past these points.
To help prevent stillbirth from prolonged labor, doctors closely monitor for fetal distress and infection. If detected, urgent delivery is recommended. Being patient but proactively managing prolonged labor can help avoid complications and stillbirth.
What is the outlook for babies born after prolonged labor?
The outlook for babies born after prolonged labor is generally very good, especially if they were delivered in good condition without significant complications. Most babies recover quickly from any effects of prolonged labor like molding or temporary reflex changes. Serious risks like infection, brain damage or stillbirth are rare.
With close fetal monitoring and proper management of labor, most babies are born healthy despite prolonged labor. Be sure to discuss your individual risks with your provider. Notify them immediately if you see any potential signs of fetal distress like decreased movements. Being proactive can help ensure the best outcome.
How is prolonged labor managed?
There are several steps providers can take to help manage prolonged labor and delivery:
Monitoring baby
Fetal heart rate monitoring helps detect early signs of fetal distress so prompt action can be taken. Options include:
– Intermittent external monitoring
– Continuous external monitoring
– Internal monitoring with a fetal scalp electrode
Monitoring the amniotic fluid for meconium provides additional information.
Laboring down
If close to complete dilation, laboring down can allow gravity and contractions to help bring the baby lower before pushing. This avoids rushing into operative delivery.
Position changes
Changing position frequently like walking, lunging, or squatting can help labor progress and allow gravity to assist descent.
Pain relief
Epidurals often prolong labor but provide rest between contractions. Narcotics like fentanyl are shorter acting options that take the edge off pain.
Oxytocin augmentation
Synthetic oxytocin administered through an IV can help strengthen weak contractions if needed. Dosage is adjusted based on response.
Amniotomy
Breaking the amniotic sac releases prostaglandins that may help speed up labor if contractions are inadequate.
Operative vaginal delivery
Vacuum or forceps assisted delivery provide traction to help guide the baby out quickly if fetal distress is suspected or labor stalls.
Cesarean delivery
A c-section becomes necessary if complications arise and vaginal delivery is no longer the safest option. mom’s preferences are also considered.
Careful fetal monitoring and trying the above interventions can often achieve vaginal delivery despite prolonged labor. But cesarean delivery may become indicated for maternal or fetal indications.
Tips for coping with prolonged labor
Some tips that may help mothers cope physically and emotionally with a prolonged labor:
– Stay hydrated – Drink fluids regularly to prevent exhaustion. Broth, juice, ice chips and popsicles are good options.
– Urinate frequently – A full bladder can slow labor. Notify staff if help is needed.
– Change positions – Upright positions use gravity. Laying on the side provides rest between contractions.
– Take breaks between contractions – Conserve energy since labor may be long. Sleep if you can.
– Use relaxation techniques – Visualization, meditation, and controlled breathing can provide a mental break.
– Apply hot/cold therapy – Hot compresses or a cold pack can relieve lower back pain.
– Eat lightly – Nibble on crackers, yogurt and fruit to maintain energy.
– Stay in contact with your support team – Phone calls, texting, and words of encouragement can help manage stress.
– Communicate with your provider – Share feelings and ask questions so you understand what’s happening.
– Remain patient and positive – Focus on each contraction at a time trusting your providers.
– Pain relief options – Discuss choices like an epidural, narcotics, tubs, and massage with your provider.
Conclusion
Prolonged labor lasting longer than 20 hours for first-time mothers and 14 hours for mothers who have previously given birth can increase risks like fetal distress and infection. However, with modern medical care the outlook remains very good for babies born after prolonged labor. Staying patient, closely monitoring the baby, managing pain, trying different techniques to aid labor progression, and delivering if complications arise are key to optimal outcomes.