Understanding Slow Labour Progress
Latent labour covers the period of time from the beginning of labour to the point when dilation begins to progress actively. This is generally from the onset of regular contractions to the point where the woman's cervix is 3-4cm dilated. Little to no descent of the presenting part occurs during the latent phase. Contractions become more established, increasing frequency, duration, and intensity. Usually women are happy and excited that the end of the pregnancy has come.
Labour duration can vary from woman to woman. Those women experiencing their first labour tend to average a 8-9 hour of labour latent. labour is consider prolonged if it last upwards of 20 hours. Women having their second or subsequent labour tend to have latent labour lasting approximately five hours. For those more experienced mothers latent labour is considered prolonged if it lasts more than 14 hours.
The "active" phase covers the period of time from the start of active progression of dilation to completion of dilation, generally from 3- 4 cm to 10cm dilated. Progressive descent of the presenting part occurs during the latter part of the active phase and during pushing. A prolonged active phase is defined by the total duration of hours in labour, or failure of the cervix to dilate. Normal first-time mothers can expect active labour for six hours, with an upper limit of about 12 hours. Women having their second or subsequent labours normally take three hours to fully dilate, and have an upper limit of six hours to dilate at this stage. A dilation rate of 1 cm per hour is typical.
The second stage of labour refers to a time from full dilation to the birth of the baby. First babies usually take an hour to be born with upper limits of three hours. Women with 2 or more babies average 20 minutes but have a upper normal of 1 hour. Slow second stage is encouraged with position changes, information on effective pushing techniques, and sometimes through medical interventions such as forceps.
Prolonged or slow progress is caused by a combination of factors including the cervix, the uterus, the fetus, and the mother’s pelvis. The power of a woman’s contractions will obviously have an effect on the rate of dilation. labour contractions generally start mild and progress in intensity with time. The interval between contractions shortens and the duration and strength of the contraction increases. The midwife will be monitoring a woman’s labour and looking for signs of progression. This is done through monitoring the contractions and vaginal exams.
If labour is not progressing and the power of contractions does not seem to be increasing interventions will sometimes be required. Natural methods of intervention used to promote labour include nipple stimulation, position changes, food and fluids, herbs, homeopathy, and rupturing the membranes. A more medical approach may involve having an intravenous with a hormone called oxytocin.
The baby’s positioning is very important for the progress of labour. Some problems that can occur include:
- A posterior baby has its back lined up along the woman’s back rather then with its back anterior towards her abdomen. This is known as "back labour". Forward sitting in the last trimester can help prevent this type of labour.
- The baby may not a have a well-flexed head. Flexing the head presents the smallest diameter first.
- The baby’s head may be ascynclitic (not centered or crooked to one side).
A women’s pelvis or bones must be internally shaped to allow a baby’s head to fit through its diameter. The psychology or a woman’s mental state can also factor in. It’s important that a labouring women feel safe and relaxed. Fear or stress can interfere with labour progress.
Help with a Slow Prolonged Labour
Try to get lots of rest before labour begins. When your labour starts, try to stay relaxed. It’s easy to get overly excited and wear yourself out early. Instead, think about getting enough rest, eating well-balanced foods, and drinking plenty of fluids. There are so many factors that can cause a prolonged labour it's important to recognize that some may correct themselves but others won’t no matter what you do. In situations where labour is prolonged and none of the suggestions the midwife makes seem to change the pattern, sometimes medical interventions are needed. It’s important to keep all avenues open and sometimes medications can help the woman get some much-needed rest.
Natural Pain Relief
- Supportive Companion(s) -- Think carefully about the people who will attend your birth. Pick people who will help you feel relaxed and supported. Women cope and progress better when they aren’t stressed out. A trained doula may be a consideration.
- Paced Breathing -- Focusing on your breath is an age-old method for managing labour and highly effective.
- Music -- Women often find rhythm and music can help them be distracted from labour discomforts.
- Water -- Many women find that warm water effectively reduces the discomfort of labour contractions. Either a shower or a soak in a warm tub can be effective. You might even consider a water birth if water has helped you with relaxation and pain in the past.
- Massage/Therapeutic Touch -- Having someone massage or apply pressure on your back often is helpful to reduces the sensations during a tightening.
- Apply heat or cold -- Heat often promotes relaxation while cold compresses can numb an area.
Pharmacological Pain Relief
With prolonged labour pharmacological pain relief may prevent exhaustion by promoting rest but can also bring with them the possibility of negative side-effects. Some commonly used treatments include:
- Sedatives, Hypnotics and Tranquillizers administered in pill form may be helpful to reduce anxiety and promote relaxation. Side effects include: dizziness, low blood pressure, sleepiness, and occasionally nausea or restlessness.
- Narcotics, such as Demerol/Phentenol, administered by injection or intravenously can reduce pain, promote sleep and relaxation. They generally last longer with injection into muscles, and act more rapidly if injected intravenously. Side effects: nausea, drowsiness, may cause respiratory depression in the newborn.
- Inhalation Analgesics such as Entonox 50% oxygen/50% nitrous oxide administered by facial mask are rapid acting with minimal or no side effects.
- Epidural catheter placed between lumbar vertebrae can be quite effective at relieving labour discomforts but requires an intravenous, continuous monitoring of the fetal heart rate, frequent blood pressure checks, and catheter placed into the bladder. Side effects: may cause blood pressure to drop, itchiness, may interfere with internal rotation of the baby and increase likelihood of assisted delivery. It may also cause depression in newborn. In rare cases, epidurals can cause spinal headache if improper placement occurs.